Application forms for licences and permits

Application forms have been developed for a range of business types, to ensure the Department receives the information needed to assess the application. Please check you are using the application form most relevant to your type of business.

There are two types of applications:

• Application for a new licence or permit
• Application to make changes to an existing licence or permit.

Application forms under each heading are as follows:

• Licences to sell medicines or poisons: indent, Schedule 2, Schedule 7 retail and wholesale/manufacture licences.
• Health service permits, with separate application forms for different types of healthcare services.
• Other permits: veterinary practice, industrial, research/education, pharmaceutical samples and stockfeed manufacture.

The fee to apply for a new licence or permit includes an application fee plus an annual fee. If the licence or permit is not issued, only the annual fee is refundable.

Changes to an existing licence or permit may incur a fee.

If there is a change to the ownership of the business, a new application is required. If the licence or permit is to be changed in type between individual (on behalf of the business), partnership or corporate, a new application is required.

Please read the Guide to applying for a Licence or Permit (Word 439KB).

Information about the applicant

All applicants must complete the personal information sections of the relevant application form.  If the licence or permit is to be issued to a partnership, each partner must complete this section of the application form.

If the licence or permit is to be issued to a corporation, each corporate officer (including directors, company secretary, chief executive officer or general manager and chief financial officer) must complete this section of the application form.

The application forms on this page are for licences to sell medicines or poisons.

Indent

You need to use this application form if you provide a sales brokerage service to supply medicines and/or poisons but do not take possession of those medicines and poisons:

Application form for a new Indent Licence (Word 182KB).

If you have an existing Indent Licence, and you require changes to the licence, you need to use this form:

Application form to change an existing Indent Licence (Word 283KB).

Schedule 2 retail licence

You need to use this application form if you are a country store or mine site shop and you want to sell Schedule 2 medicines in your shop:

Application form for a new Schedule 2 Retail Licence (Word 237KB).

Licences will only be issued where the nearest pharmacy is at least 25 kms away.

If you have an existing Schedule 2 Retail Licence, and you require changes to the licence, you need to use this form:

Application form to change an existing Schedule 2 Retail Licence (Word 303KB)

Schedule 7 retail

You need to use this application form if you are a business and you want to sell agricultural herbicides and pesticides in Schedule 7 to authorised users, such as primary producers:

Application form for a new Schedule 7 Retail Licence (Word 191KB).

If you have an existing Schedule 7 Retail Licence, and you require changes to the licence, you need to use this form:

Application form to change an existing Schedule 7 Retail Licence (Word 289KB).

Wholesale/manufacture licence

You need to use this application form if you are a business and want to manufacture and/or wholesale medicines and/or poisons:

Application form for a new Wholesaler’s/Manufacturer’s Licence (Word 210KB).

If you have an existing Wholesaler’s/Manufacturer’s Licence and you require changes to the licence, you need to use this form:

Application form to change an existing Wholesaler’s/Manufacturer’s Licence (Word 249KB).

These application forms are for a Health Service Permit, which is a permit to purchase medicines for use in treating the patients of a healthcare service, including imprest medicines for urgent treatment at residential aged care facilities. Please use the form that best describes the type of healthcare service you provide.

If you cannot find a suitable form on the list, please contact the Medicines and Poisons Regulation Branch for advice by phoning 9222 6883 or emailing MPRB@health.wa.gov.au.

Ambulance service

You need to use this application form if you are a business and you want to purchase Schedule 2,3 4 or 8 medicines because you are operating a service which provides ambulances and/or paramedical staff for emergency services, events, training or patient transfers:

Application form for a new permit for an ambulance service (Word 401KB).

Ambulance services will be issued with a Health Service Permit.

If you have an existing permit for an ambulance service and you require changes to the permit, you need to use this form:

Application form to change an existing permit for an ambulance service (Word 368KB).

Cosmetic procedure clinic

You need to use this application form if you are a business that wants to administer cosmetic injections:

Application form for a new permit for a cosmetic procedure clinic (Word 225KB).

Cosmetic procedure clinics will be issued with a Health Service Permit.

Please read the Cosmetic Procedure Clinic Guideline (Word 366KB) about who should apply for this type of permit.

Please note: if your medical practice provides a more comprehensive service with a medical practitioner on site whenever patients are being treated, the Application form for a new permit for a medical/dental practice (Word 395KB) should be used.

If you have an existing permit for a cosmetic procedure clinic and you require changes to the permit, you need to use this form:

Application form to change an existing permit for a cosmetic procedure clinic (Word 326KB).

First aid

You need to use this application form if you are a first aid provider at a workplace and you want to purchase Schedule 2 and 3 medicines (pharmacy over the counter products) for use at that workplace when providing first aid to staff and/or clients:

Application form for a new permit for a first aid service (Word 297KB)

The first aid provider will be issued with a Health service Permit.

If Schedule 4 (prescription only) or Schedule 8 (controlled drugs) are required, please use the Application form for a new permit for a medical treatment service (Word 401KB).

If first aid treatment is required at events and Schedule 2 and 3 medicines will be transported from the storage address to these events, please use the Application form for a new permit for an ambulance service (Word 401KB).

If you have an existing permit for a first aid service and you require changes to the permit, you need to use this form:

Application form to change an existing permit for a first aid service (Word 300KB).

Immunisation service

You need to use this application form if you are an immunisation provider and you want to purchase vaccines for use at specific sites or as part of a mobile service (such as a service that holds vaccine clinics at workplaces):

Application form for a new immunisation service (Word 366KB).

Immunisation services will be issued with a Health Service Permit.

If you have an existing permit for an immunisation service and you require changes to the permit, you need to use this form:

Application form to change an existing permit for an immunisation service (Word 325KB).

Medical/dental practice

You need to use this application form if you are a medical or dental practice or private hospital, including a day hospital, and you want to purchase medicines for use at the practice or hospital:

Application form for a new permit for a medical/dental practice (Word 395KB).

Please note: a permit is only required where you want to pool medicines for use by all practitioners.

Individual prescribers are authorised to purchase medicines under their own name and use those medicines to treat their own patients. This includes medicines provided to medical practitioners and nurse practitioners as Pharmaceutical Benefits Scheme (PBS) | Prescriber Bag Supplies (external site).

Medical and dental practices and private hospitals will be issued with a Health Service Permit.

If you have an existing permit for a medical or dental practice or a private hospital and you require changes to the permit, you need to use this form:

Application form to change an existing permit for a medical/dental practice (Word 356KB).

Medical treatment

You need to use this application form if you are a medical business and you want to purchase medicines for providing medical treatment services to third party sites, such as mining and resource industry sites:

Application form for a new permit for a medical treatment service (Word 393KB).

Medical treatment businesses will be issued with a Health Service Permit.

If you have an existing permit for a medical treatment service and you require changes to the permit, you need to use this form:

Application form to change an existing permit for a medical treatment service (Word 367KB).

Residential care

You need to use this application form if you are a residential care facility and you want to purchase imprest (also called stock supply) medicines for the facility:

Application form for a new permit for a residential care facility (Word 394KB).

Residential care facilities will be issued with a Health Service Permit.

A permit is not required for medicines that have been dispensed for individual residents by a pharmacy.

If you have an existing permit for residential care and you require changes to the permit, you need to use this form:

Application form to change an existing permit for a residential care facility (Word 355KB).

These permits are to allow purchase and use of medicines and poisons for business activities other than operating a healthcare service.

Veterinary practice permit

You need to use this application form if you are a veterinarian operating a business and want to purchase medicines for use in your business. This type of permit is suitable for veterinary clinics, veterinary hospitals and veterinarians who operate as a mobile vet.

Application form for a new Veterinary Practice Permit (Word 390KB).

Please read the guideline about Who needs a veterinary practice permit (Word 361KB).

If you have an existing Veterinary Practice Permit and you require changes to the permit, you need to use this form:

Application form to change an existing Veterinary Practice Permit (Word 351KB).

Industrial permit

You need to use this application form if you are a business (including sole traders) and you want to purchase poisons for industrial use in your business:

Application form for a new industrial permit (PDF 1MB).

A permit is not required to purchase and use poisons in Schedules 5 and 6.

This form is not for people who want to sell poisons in their business.

If you have an existing Industrial Permit, and you require changes to the permit, you need to use this form:

Application form to change an existing Industrial Permit (Word 294KB).

Research or education permit

You need to use this application form if you are a school, university, government department or research organisation and you want to purchase medicines or poisons for use in education or research:

Application form for a new Research/Education Permit (Word 395KB).

If you have an existing Research/Education Permit and you require changes to the permit, you need to use this form:

Application form to change an existing Research/Education Permit (Word 352KB).

Pharmaceutical samples permit

You need use this application form if you are pharmaceutical representative and you want to store and carry pharmaceutical samples:

Application form for a new Pharmaceutical Samples Permit (Word 296KB).

If you have an existing Pharmaceutical Samples Permit and you require changes to the permit, you need to use this form:

Application form to change an existing Pharmaceutical Samples Permit (Word 121KB).

If you move to a different pharmaceutical company, a new application is required.

Stockfeed manufacture permit

You need to use this application form if you are a stockfeed manufacturer and you want to purchase prescription medicines (antibiotics) for adding to feed mixes:

Application form for a new Stockfeed Manufacture Permit (Word 257KB).

If you have an existing Stockfeed Manufacture Permit and you require changes to the permit, you need to use this form:

Application form to change an existing Stockfeed Manufacture Permit (Word 286KB).

If you have a current licence or permit, a renewal form will be posted to you approximately two months before it is due to expire.

To renew your licence or permit you must return the completed and signed renewal form to the Medicines and Poisons Regulation Branch and pay the renewal fee. Fees can be paid by BPay or BPOINT. BPOINT payments (external site) can be made using a Mastercard or Visa credit card.

If your current licence or permit has been lost or destroyed, a replacement copy can be supplied. A fee of $44 is payable. Please contact the Medicines and Poisons Regulation Branch to obtain an application form to replace a licence or permit. This form will include details of how to pay.