MASS Reference Card Request Form

Privacy Notice

The Medical Aids Subsidy Scheme (MASS) is collecting your personal information on this form to confirm your identity and send you a MASS reference card to your nominated postal address and/or to update your details. Your personal information will be used by authorised officers within the Medical Aids Subsidy Scheme.

Please refer to our privacy statement for further information on how Queensland Health handles your personal information.

Required fields are marked with an asterisk (*).

Update Details or Request MASS Reference Card Form

Request Type * You must be an existing MASS client to request a MASS reference card.

Name *

Date of Birth *

Reference Number (URN) Also known as a "B Number" (if known)

Email Address *

Postal Address and/or Comments * Please specify the address you require the card to be posted to. If you have updated details, please specify below (e.g. previous/new name)