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.
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.