AH Prescreening Form (Enrolled)

After-Hours Appointment Request - Enrolled Patients

Kia ora. Please complete this form to access your subsidised after-hours GP appointment.
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Mobile Number*

Prefix (027, 021, 022)Phone
Email*
example@example.com
Thank you for your request for the After Hours Service. You will receive an email which contains your unique code to access the subsidised rates available to you as a valued Ngā Kākano patient.

Please check your email and follow the link to book your after hours appointment via Practice Plus.

Ngā mihi
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After-Hours Appointment Request - Enrolled Patients