Update Healthcare Provider Details 

Tell us about changes to provider details (practice/facility details or practitioner details) by using the form below. If you are a Southern Cross member and want to update your membership details, please go to the member contact details form.

Start by providing your details so we can contact you to verify changes, if necessary.

* Indicates a required field

1. Your details
2. Change or add practice/facility details
Old details (if applicable)
New details
Reason for change
(eg. 'change of ownership' or 'moved premises')
3. Change or add practitioner details
Old details (if applicable)
New details
Reason for change
(eg. 'practitioner has retired', 'change of name' or 'change of contact details')