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7 Polarity Rise, Silverdale
(09) 427 9997 Enrolment Form and Questionnaire 我们提供华语医生服务



Online Enrolment Form

Click here to open the Online Enroment Form (opens in a new window)


Data Privacy Flyer (PDF, opens in new window)

How do I enrol?

To enrol you must be eligible, entitled and complete the online enrolment form..

You will need to provide evidence of citizenship or eligibility for publicly funded health services; please do
not be offended when asked.

What are the enrolment criteria?

1. I am entitled to enrol because I am residing permanently in New Zealand.*

2. I am eligible to enrol because I meet one of the eligibility criteria listed below:

a) I am a New Zealand citizen OR

b) I hold a resident visa or a permanent resident visa (or a residence permit if issued before December 2010) OR

c) I am an Australian citizen or Australian permanent resident AND able to show I have been in New Zealand or intend to stay in New Zealand for at least 2 consecutive years OR

d) I have a work visa/permit and can show that I am able to be in New Zealand for at least 2 years (previous permits included) OR

e) I am an interim visa holder** who was eligible immediately before my interim visa started OR

f) I am a refugee or protected person OR in the process of applying for, or appealing refugee or protection status, OR a victim or suspected victim of people trafficking OR

g) I am under 18 years and in the care and control of a parent/legal guardian/adopting parent who meets one criterion in clauses a–f above OR in the control of the Chief Executive of the Ministry of Social

h) I am a NZ Aid Programme student studying in NZ and receiving Official Development Assistance funding (or their partner or child under 18 years old) OR

i) I am participating in the Ministry of Education Foreign Language Teaching Assistantship scheme OR

j) I am a Commonwealth Scholarship holder studying in NZ and receiving funding from a New Zealand university under the Commonwealth Scholarship and Fellowship Fund.

You will need to tick the eligibility criteria that applies to you on your enrolment form. For further information about eligibility, please refer to

Other circumstances where you may be asked to sign an enrolment form:

Casual patient
If you do not meet the enrolment criteria and wish to be a casual patient, please complete a separate .Casual Patient Details’ form.

Enrolling children (under 16 years)
Parents can enrol and sign for children under 16 years of age, but children 16 years or over must sign their own form.

Enrolling someone else (other than children)
In some circumstances, you may sign for another person if they are unable to consent on their own behalf. This is referred to as ‘Signed by Authority’.

Frequently asked questions

What happens if I go to another general practice?

You can go to another general practice or change to a new general practice at any time, if you are enrolled in a PHO through one general practice and visit another practice as a casual patient you will pay a higher fee for that visit. So if you have more than one general practice you should consider enrolling with the practice you visit most often.

What happens if the practice changes to a new PHO?

If the general practice changes to a new PHO, they will make this information available to you.

What happens if I am enrolled in a general practice but don’t see them very often?

If you have not received services from your general practice in a three-year period it is likely that the practice will contact you and ask if you wish to remain with the practice. If you are not able to be contacted or do not respond, you name will be taken off the Practice and PHO Enrolment Registers. You can re-enrol with the same general practice or another general practice and affiliated PHO at a later time.

* The definition residing in New Zealand is that you intend to be resident in New Zealand for at least 183 days in the next 12 months.
** If a person has an interim visa this means they are waiting for Immigration to finish processing an application. Immigration issues interim visas if the old visa has run out but the new visa is processing. To determine the eligibility of an interim visa holder you should look at what their eligibility status was immediately prior to being issued the interim visa. For example, the person had a two-year work permit and has been issued with an interim visa while waiting for their application for another two-year work permit to be processed. Immigration usually issues Interim visas in a letter form.


Your privacy and confidentiality will be fully respected. This fact sheet sets out why we collect your information and how that information will be used.


We collect your health information to provide a record of care. This helps you receive quality treament and care when you need it.

We also collect your health information to help:

  • keep you and others safe
  • plan and fund health services
  • carry out authorised research
  • train healthcare professionals
  • prepare and publish statistics
  • improve government services
  • population health and quality improvement
  • sending reminders or recalls as appropriate

Confidentiality and information sharing

  • Your privacy and the confidentiality of your information is really important to us.
  • Your health practitioner will record relevant information from your consultation in your notes.
  • Your health information will be shared with others involved in your healthcare and with other agencies with your consent, or if authorised by law.
  • You don’t have to share your health information, however, withholding it may affect the quality of care you receive. Talk to your health practitioner if you have any concerns.
  • You have the right to know where your informaton is kept, who has access rights, and, if the system has
  • audit log capability, who has viewed or updated your information.
  • Your information will be kept securely to prevent unauthorised access.

Information quality

We’re required to keep your information accurate, up-to-date and relevant for your treatment and care.

Right to access and correct

You have the right to access and correct your health information.

  • You have the right to see and request a copy of your health information. You don’t have to explain why you’re requesting that information, but may be required to provide proof of your identity. If you request a second copy of that information within 12 months, you may have to pay an administration fee.
  • You can ask for health information about you to be corrected. Practice staff should provide you with reasonable assistance. If your healthcare provider chooses not to change that information, you can have this noted on your file.

Many practices now offer a patient portal, which allows you to view some of your practice health records online. Ask your practice if they’re offering a portal so you can register.

Use of your health information

Examples of how your health information is used is outlined below:

If your practice is contracted to a Primary Health Organisation (PHO), the PHO may use your information for clinical and administrative purposes including obtaining subsidised funding for you.

  • Some health information we collect and generate is stored electronically by cloud service providers located in Australia. This information may also be processed (but not stored) by these providers in other countries. The information is encrypted at all times and these providers comply with internationally recognised security standards.
  • Your District Health Board (DHB) uses your information to provide treatment and care, and to improve the quality of its services. A clinical audit may be conducted by a qualified health practitioner to review the quality of services provided to you. They may also view health records if the audit involves checking on health matters.
  • When you choose to register in a health programme (eg immunisation or breast screening), relevant information may be shared with other health agencies or providers.
  • The Ministry of Health uses your demographic information to assign a unique number to you on the National Health Index  (NHI). This NHI number will help identify you when you use health services.
  • The Ministry of Health holds health information to measure how well health services are delivered and to plan and fund future health services. Auditors may occasionally conduct financial audits of your health practitioner. The auditors may review your ecords and may contact you to check that you received those services.
  • Notification of births and deaths to the Births, Deaths and Marriages register may be performed electronically to streamline a person’s interactions with government.


Your health information may be used in research approved by an ethics committee or when it has had identifying details removed.

  • Research which may directly or indirectly identify you can only be published if the researcher has previously obtained your consent and the study has received ethics approval.
  • Under the law, you are not required to give consent to the use of your health information if it’s for unpublished research or statistical purposes, or if it’s published in a way that doesn’t identify you.


It’s OK to complain if you’re not happy with the way your health information is collected or used.

Talk to your healthcare provider in the first instance. If you are still unhappy with the response you can call the Office of the Privacy Commissioner toll-free on 0800 803 909, as they can investigate this further.

For further information

Further detail in regard to the matters discussed in this fact sheet can be found on the Ministry of Health
website at