Cornwall Medical Enrolment Form

Enrolment Form

Thank you for choosing to be a part of the Cornwall Medical community.
Signing up is easy with just 8 steps and takes only 5 minutes. Here’s some info:
- Have a passport or photo ID ready, and proof of where you live if needed. You take a photo or you can upload pictures of these.
- You can add your family members in Step 5. Anyone 16+ you will need to enrol seperately.
- We make sure to keep your data safe; information about your data privacy is provided in Step 8.
Click "Next" to continue and start the process.

Step 1 - Choose your new Doctor

See our website for detailed profiles
PRINCIPAL GP ENROLMENT: Dr Liong's patients will be enrolled under Dr An Lim and Dr Tam's patients under Dr Wee-Ling Khoo*

Step 2 - Your enrolment status

We need to determine your enrolment status and entitlement to government funding.
Select your eligibility *
ID verification

I acknowledge that proof of my eligibility will be required as per MOH guidelines. This will be done by a member of our friendly team.
Documentation Upload (Attach Files or take Photo)

Proof of my eligibility will be required as per MOH guidelines. This can be (but is not limited to):
- NZ passport (or)
- Foreign passport AND eligible visa (or)
- NZ birth certificate AND photo ID (or)
- Australian Passport AND proof of NZ address
Upload or Photo (s)

Click again to add multiple documents
Cancelof
if you need further information on enrolment eligibility please click here

Step 6 - Dependents

Dependents under the age of 16 you would like to add to this form
Do you have any dependents you wish to add? *
Additional Dependent

Step 7 - Transfer of records

In order to get the best care possible, I agree to the Practice obtaining my records from my previous Doctor. I also understand that I will be removed from their practice register
Would you like us to transfer your records*
Previous Doctors Name

First NameLast Name
Previous Practice Name
Previous Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Practice e-mail (if known)
example@example.com
Previous Practice Phone (if known)

Area CodePhone Number

Enrolment Form