• Your Details

  • DD slash MM slash YYYY
  • Referring Health Professional (eg Doctor) Details:

  • Max. file size: 128 MB.
    View an example of a D904 form
  • Section 2 - Dept. Veteran Affairs Details

  • Max. file size: 128 MB.
    Please attach a screenshot of your MyService account (via your myGov login) that details your accepted conditions for the purposes of noting the exact medical wording for DVA claims. Please visit here for more information
  • Declaration