Enrolment
Thank you for your interest in registering with our healthcare practice.
When you complete this form, you have the option of enrolling with the general practice primary health organisation (PHO) of which this practice is a member or registering as a casual patient without enrolling. Whilst enrolment with a PHO is voluntary, enrolment provides you and your whānau | family with access to subsidised healthcare services including reduced costs for doctors' visits and prescription medications.
You can only be enrolled at one healthcare practice at a time, but you can change your enrolled practice at any time should you wish to move to another healthcare practice.
To enrol, you must meet criteria as detailed on the Te Whatu Ora | Health New Zealand website enrolment page. If you are a New Zealand Citizen, Permanent Resident, or hold a work visa, you will be eligible to enrol. The information collected at enrolment is subject to the Privacy Act 2020 and the Health Information Privacy Code 2020, so the privacy of your information is protected. To enrol, you will need to provide proof of eligibility by uploading documents as evidence of your eligibility to enrol.
If you are not eligible or do not wish to enrol at this practice, you can also use this form to visit the practice as a casual patient. All patients who are not enrolled with the practice are considered to be casual patients.
Fill in the first column for the primary account holder. Once this is done, you can add or subsequently remove family members by clicking the ADD or DELETE buttons respectively.
A right arrow sign allows you to copy details from the main account holder to family members.
The red cross mark will change to a green tick if all items in that row are valid. Items without this mark are optional.
A green plus mark can be clicked for a new dialog screen to add special items.
For the next-of-kin section, the primary account holder is the default entry for all family members. You can also copy details from one family member to be the main account holder's next-of-kin.
For eligibility documents, you need to process this for each family member individually. On a computer, you can upload one or more documents from your file system. If you are on a mobile device, you have the option of using your device camera to take a photo instead.
The main account holder should sign on the area at the bottom. If this is not done, a text signature based on your name will be used instead.
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Enrol (Transfer)
Register (Casual)
Please sign on your device screen or using a mouse.
The signature is optional and if unsigned, a computer-generated signature will be used instead.
If you are enrolling, the signature will be used to request for a transfer of your medical records from your previous GP.
An email and a contact phone number are both needed to register or enrol with our clinic.
This is because our staff need to be able to communicate with you in order to provide a good service.
If you do not have an email or phone contact, please register using the manual form at reception.
