Health Care Facility Licence Variation

About this form

This form is to be used to apply for a variation to a Health Care Facility Licence under the ACT Health Care Facilities Code of Practice 2001, an enforceable Code of Practice under the Public Health Act 1997.

There is no fee required to submit this form.


A copy of the original licence certificate must be attached to this application.

More information

For more information, see Health Care Facilities Licensing.

Your personal information

Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.

For details on the collection of personal information in this form please refer to the Access Canberra Information Collection Notice. If you have questions about how your information will be handled please see the Access Canberra Privacy Policy and the ACT Health Privacy Notice or contact us.