Whānau puka tuku / referral form

You can enrol yourself, a whānau member or someone you care for, for Te Piki Oranga services.

• Other healthcare and community service providers can also enrol someone using these forms.

• If you are enrolling someone on their behalf, please ensure that you have their verbal consent first.

• We aim to reply within 72 hours. For more urgent enquiries, please phone 0800 672642.

How to send a printed form back to us

1. Fill out the form using PDF editing software such as Adobe, and email it to us: admin@tpo.org.nz

2. Fill out the form by hand (using a pen) and either:

   i) scan it and email it to us: admin@tpo.org.nz

   ii) post it to us using the contact details on this page

   iii) bring it in to one of our health hubs at the addresses on this page

Other ways to access our health services

If you are unsure which healthcare services are suitable, or want to speak with someone: Please use the contact details listed on this page.