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Variation application form

Variation application form

This form must be completed and submitted in one session. You cannot save a partially completed form. Please ensure you have all information and documentation about your immediate action or prohibition order and request for variation.

Alternatively, you can download a Variation application form (DOC, 112KB) to complete, and email or print and post back to us.

Contact us if you need help to fill in the form.

Personal details and contact information

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(if currently working in a health service / support service to a health service)