Email Appointment Form

Email Appointment Form

Kia ora. During the COVID-19 Lockdown all appointments with GP or Nurse are done by phone first. Please complete the form below to help us process your request.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

Town Province

Post Code
Date of Birth *

Day Month Year
Date
Mobile Number
Email
example@example.com
What are you contacting us about? *

Prescription/ Medication request Flu vaccination Child immunisation GP appointment Other 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 do you want an appointment with? *

Any available doctor Asthma and Respiratory Coordinator Diabetes Nurse Tamariki Ora Well Child Nurse Alcohol and Drug Counsellor Mental Health Practitioner
Preferred times (please tick all that you can make): *

Monday AM Monday PM Tuesday AM Tuesday PM Tuesday PM EVENING (for all non-GP services above) Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM
Please note any further details about your appointment.
(for example - immunisation for daughter Miria Maxwell-Crawford, if possible after school any time after 3pm)
Should be Empty: