IVF Medicare Rebate Class Action
Register your intrest in the class action:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your DoB
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
What ART procedures have you undergone?
*
In-vitrofertilisation (IVF)
Gamete intrafallopian transfer (GIFT)
Intracytoplasmic sperm injection (ICSI)
Intrauterine insemination (IUI)
Other
Did you recieve a Medicare rebate for all of the procedures you had?
*
Please Select
Yes
No
Partial or unsure
Please Specify
Other comments
Do you wish to sign the Funding Agreement? (as described and explained in the FAQ section of the website www.ivfrebatesclassaction.com.au)
Yes
No
Would you like to download an independent advice to Group Members in relation to the Funding Agreement?
Yes
No
By checking the box below, you acknowledge and agree that the information you are about to access is provided solely for individuals who are, or genuinely believe that they may be, Group Members in this proceeding, and is made available for the express purpose of enabling them to obtain independent advice or to register as a Group Member to the proceeding.
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Please download the advice agreement by clicking the download arrow below:
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