Department of Health and Human Services

Victorian Maternity Record Order Form

The Victorian Maternity Record can be ordered online by filling out the details below and pressing "Submit" at the bottom of the page. Note: we do not ship outside of Victoria.

Contact details

Contact Name:
Department Name:
Organisation Name:
Post Code:
Phone (include Area Code):
Fax (include Area code):
Email Address:


For those services with their own tailored VMR kit, you are now able to order the VMR form only.
Document Title Code Number of copies
Victorian Maternity Record VMR Kit (minimum 20)*
VMR form only VMR Form (minimum 100)*

* Please note that the minimum number of VMR kits that can be requested in a single order is 20. Ordering 50 VMR kits and above, in increments of 50 (ie 50, 100, 150, 200) is preferred. The minimum number of VMR forms that can be requested in a single order is 100. Ordering VMR forms in increments of 100 (ie 100, 200, 300) is preferred.