aglow

Treatment Wallet

Hardship & exceptional circumstances application

For Treatment Wallet holders applying for a refund or other relief under clause 7.2.

Step 1 of 7 · Before you apply14%

Before you apply

Clause 7.2 of the Wallet Holder Terms & Conditions allows aglow to refund a wallet balance where we are reasonably satisfied there is genuine hardship or exceptional circumstances. This form is how you apply.

A refund is not the only outcome. We can also pause your contributions, reduce the amount, transfer your balance to another aglow-enabled provider, or refund part of it.

Grounds we can consider: medical injury or illness; financial hardship; and permanent relocation to a location where attending your clinic is no longer reasonably practicable. Other exceptional circumstances can be considered on their merits.

What this form is not for: clause 7.1 excludes change of mind, convenience and buyer's remorse. An application describing only a change of mind will be assessed under 7.1 and declined, with reasons given.

Your contributions are paused as soon as we receive your application, so nothing further is debited while we assess. Assessments may take up to 30 days.

Supporting information

Every application needs the declaration in Part E plus at least one supporting document. Examples: a doctor's letter or medical certificate, a termination letter, a Centrelink statement, a bank statement, or a lease or proof of new address.

Treatment Wallet balance under $500
Declaration, plus at least one supporting document relevant to the ground claimed
Treatment Wallet balance over $500
Declaration, plus supporting documents, reviewed by a second assessor
Medical injury or illness
A medical certificate confirming the fact and period of incapacity. No diagnosis or clinical detail required.
Financial hardship
A Centrelink statement, a separation or redundancy letter, or a hardship arrangement with another provider
Permanent relocation
A lease, utility connection or employment letter showing the new address
Other exceptional circumstances
Whatever reasonably evidences the circumstance you describe

Medical grounds: please do not send diagnoses, test results or clinical records — we will not retain them if you do.