My declaration of entitlement and eligibility

(for public funding)

Enrollment

I understand that by enrolling with Epic Health Medical Practice I will be enrolled with the Western Bay of Plenty PHO -Primary Health Organisation. My name, address and other identification details will be included on both the practice and PHO enrolment registers.

I understand that if I visit another 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 with the PHO and their contact details. 

I have read and I agree with the Health Information Privacy Statement in the accompanying PHO link https://wboppho.org.nz/privacy-policy/ 

I agree to inform the practice of any change in my eligibility.