Isolation Aroha Tautoko Packs

Isolation Tautoko Form

If you have been instructed by The Ministry of health to isolate and are in need of support please fill in this form.
Name*

First NameLast Name
Contact number*
Please ensure this is correct as we may need to call to for a faster process
Isolation Address*
Please ensure this is correct as per the information Ministry of health will have.
Email*
example@example.com - Please make sure this is correct and you are checking all emails.
I have tested positiveI am a close contact - Live with the positive case
Please attached confirmation letter from The Ministry of Health confirming you need to isolate. (This document is essential for your application to be successful)*

Cancelof
Are you currently receiving support from any other organisation? If yes, please tell us who and what support yo are receiving?*

Let us know what you need and how urgent your need is:*

TissuesSoapSanitiserMasksParacetamol
If there is anything you may be in need of but is not listed above, please let us know below:
Please note: we DO NOT supply household items like bedding, Kitchenware, Clothing, Car Payments or Bill payments and Furniture.
How many people are isolating in your household?*
How many days are you required to self Isolate?*
How many days do you have left in isolation?*
Isolation can be a very challenging period and you may have many questions. We have added a few links that can support you through this whole process. It is important to know that we are here to support you, so please do not feel ashamed to reach out - All information you share with us can be kept confidential.

Dont know what Isolation means for you?
There are diffrent periods for isolation depending on what contact you have with the positive case. You can look here - https://covid19.govt.nz/isolation-and-care/how-to-self-isolate/

Need more support?
The government has set up multiple support lines to make isolation as easy for you as possible. Please see these links for further information - https://covid19.govt.nz/isolation-and-care/getting-extra-support-if-you-have-covid-19-or-are-self-isolating/
I AGREE
YESNO
Should be Empty:

Isolation Tautoko Form