Appointment Form

Appointment Form

Kia ora! Please complete the form below to request an appointment.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownProvince

Post Code
Date of Birth*

DayMonthYear
Date
Mobile Number*
Please ensure your contact number is correct so our kaimahi can call you
Email*
example@example.com
What are you contacting us about?*

Prescription/ Medication requestFlu vaccinationChild immunisationGP appointmentOther type of nurse appointment
Please give details of prescription request or reason for appointment request below.
Thank you, we will make contact with you before the end of today (if you have submitted this before 3pm).

If between 3-5pm and you feel your request is urgent please call us on 573-0660. If it’s after hours, we will contact you tomorrow or on the next business day.

Nga mihi
Who would you like to book an appointment with?*

Any available doctorDr Melanie Stephen (available Mon-Wed)Dr Colin Katzen (available Tue-Fri)Telehealth - Dr Khalid Shar (available Mon/Thur/Fri)Practice Nurse
Do you have a preference in day :*

MondayTuesdayWednesdayThursdayFridayNo Preference
Do you have a preferred time of the day:*

Morning (Between 9.00am - 12.00pm)Afternoon (Between 1.00pm - 4.00pm)
Please provide a brief explanation for your request:
Ngā mihi! One of our kaimahi (staff) will be in touch with you shortly.

PLEASE NOTE:

If this is a medical emergency, please call 111 immediately

If your request is submitted BEFORE 3.00pm we will attempt to contact you before the end of today.

If your request is submitted AFTER 3.00pm and you feel that your request is urgent, please call us on 07 573 0660. Otherwise, your request will be actioned the next working day.

If your request is outside of our normal business hours (8.30am-5.00pm Mon-Fri), please refer to our Telehealth After-Hours service.
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