• MAIA SERVICE REFERRAL FORM

    MAIA SERVICE REFERRAL FORM

    For Māia, service and other support queries
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    WELCOME

    You are making a referral to the Te Ora Puāwai Māia Navigation service.

    If you have any queries before you complete this form, please email us at customerquery@teorapuawai.nz and one of our staff will get back to you within 48 hours of receiving this referral.

    Māia: Is a free service for people who have:

    • Two or more Long Term Health Conditions
    • And or a Disability

     

  • REFERRER DETAILS

    Please complete your details below
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  • CUSTOMER DETAILS

    Please complete customer details below
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  • CUSTOMER BASIC MEDICAL INFO

  • CRITERIA - Medical alerts. Please state at least 2 long-term health conditions e.g. Diabetes, Cancer etc. and /or any disabilities

  • Referral information

    Tell us what you would like us to focus on with your referral
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