Subsidies Form - Thermoregulatory Dysfunction

Form
Thermoregulatory dysfunction energy subsidy scheme.
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The Thermoregulatory Dysfunction Energy Subsidy provides financial assistance for persons with thermoregulatory dysfunction, or their dependants, to offset energy costs for controlling the temperature in their home. See the fact sheet for information about this subsidy.

Complete the application form

It’s fastest and easiest to use the online application form using your Online Services Portal account. The online form will be sent to your doctor or specialist to complete the medical authorisation, then will automatically be submitted to RevenueWA.

For information about applying online or setting up an account, see the Energy Subsidy Schemes Portal Guide.

If you are unable to apply online, use the paper-based form attached below. The doctor or specialist must complete the medical authorisation section of the application form before it can be submitted.

What you need when applying
Concession card details
  • Card number
  • First name as listed on the concession card
  • Surname as listed on the concession card
Bank account details

You will need the following information about the Australian savings or cheque account you are nominating to receive payment:

  • Name of financial institution (e.g. ANZ Bank)
  • BSB number (maximum 6 digits)
  • Account number (maximum 9 digits)
  • Name of account holder

Medical authorisation

If applying online, provide the email address of the doctor or specialist.