*Please be advised that applications will generally only be processed if the start date is within the next 4 days otherwise your application may be cancelled and you will be advised to re-apply within four days of the start date.

By completing this form, you acknowledge that you are providing the personal and health information as required under the Drugs, Poisons and Controlled Substances Act 1981 (the Act) to the Department of Health, Victoria (the Department) for the purpose of applying to, or notifying, the Department in relation to a Schedule 8 treatment permit.

The information is handled by the Department in accordance with the requirements of the Act, Drugs, Poisons and Controlled Substances Regulations 2017 (Vic), Privacy and Data Protection Act 2014 (Vic), Health Records Act 2001 (Vic) and the Department’s privacy policy.

The information collected by the Department:

•will be used and disclosed for the purposes of assessing the permit application or meeting notification requirements;•will be used and disclosed for monitoring and compliance purposes;•may be disclosed to other relevant health practitioners when necessary to facilitate coordination of the patient's drug treatment and safe prescribing of drugs; and•may be disclosed for any other purposes permitted by law including but not limited to reporting or investigation of suspected unlawful activity to regulatory and law enforcement agencies in the Commonwealth, States and Territories; and Ahpra.
By submitting this form, health practitioners confirm that the patient: •is aware of the contents of this collection notice; and•has consented to the form being submitted.
If you do not provide all the required information, the application may not be processed.

You can download a PDF copy of the completed form or request a confirmation email at the Submission Complete page.

For further information about Victorian Drugs and Poisons legislation, please visit www.health.vic.gov.au/dpcs.

For further information on privacy and how to access and seek correction of personal information about you held by the Department, visit www.health.vic.gov.au/privacy.

Pre-fill feature available
Simply tick the “Remember Me” checkbox below and this will save your details, enabling you to use these again next time, saving you time. Note: the “Remember Me” function is browser and computer-specific.
If you use one computer the first time and then a different computer the next time you submit information, the previously saved details using "Remember Me" tick box will not be available. The same applies if you use the Google Chrome browser initially to complete the form, and then use Microsoft Edge browser to complete it (previous Internet Explorer), you won't be able to access the saved prescriber details. You are advised to use the same computer and same web browser each time when completing the forms online.

By unticking the checkbox below the Prescriber Details that have been saved on this computer will be removed.