• Caring Clinic Drs Enrolment Form

    Level 8, 175 Queen Street, Auckland 1010 Ph09 2222577 Fax09 2222575 EDI:caring8q GP2GP: Dr R Sim MCNZ38537
    Caring Clinic Drs Enrolment Form

  • Thank you for choosing to enrol with us. Please fill in the form accurately. It will usually take about 1-2 minutes to complete. If you can't find the relevant documents to upload, you can email them to us later at info@caringclinic.co.nz shortly after your submission.

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  • My Declaration of Entitlement and Eligibility

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  • My Agreement to the Enrolment Process

    I intend to use this practice as my regular and on-going provider of general practice / GP / health care services.

    I understand that by enrolling with this practice, I will be included in the enrolled population with the Primary Health Organisation (PHO) this practice belongs to, and my name address and other identification details will be included on the Practice, PHO and National Enrolment Service Registers.

    I understand that if I visit another health care provider where I am not enrolled I may be charged a higher fee.

    I have been given information about the benefits and implications of enrolment and the services this practice and PHO provides along with the PHO's name and contact details.

    I have read and I agree with the Use of Information Statement. The information I have provided on the Enrolment Form will be used to determine eligibility to receive publicly-funded services. Information may be compared with other government agencies, but only when permitted under the Privacy Act.

    I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.

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