Request to Transfer Medical Records

Please note:

Each person 16 years or older needs to complete and sign their own form.
Please tell us the name and address of your previous Doctor or Medical Centre*
In order to receive the best care possible, I agree to Pihanga Health obtaining my medical records from my previous doctor. I also understand that I will be removed from the register of my previous practice.

Please transfer all medical records for the following people to Pihanga Health:
Your full name*

All your given namesYour last name
Your birthday*

DayMonthYear
Your NHI number (if known)
Signature*

Clear
Todays date

DayMonthYear
Additional family members
Add the FULL NAME and DATE OF BIRTH for all family members UNDER 16 yrs old who you are also including in this request for medical records
To the Medical Centre

Please send the medical records for the above patients to us at Pihanga Health. We prefer to receive notes electronically through GP2GP transfer.

Pihanga Health 28 Te Rangitautahanga Road, Turangi, 3334

EDI: turanghc

Phone: 07 384 7576 Fax: 07 384 7552
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