POAC Infusion Centre Registration

POAC Infusion Centre Registration

For provision of services within the Auckland Region
This form can be used to register your Auckland region organisation to receive referrals for the following POAC-funded services from external referring clinicians:

- Ferinject Iron Infusion

- Aclasta Infusion

- LARC Services

- Pipelle Biopsy

By submitting this form, the provider agrees to follow POAC terms and conditions of use, including confirming suitably trained and qualified clinical staff available promptly to receive referrals, contact referred patients, and deliver services in a safe clinical environment.

For more information on specific services, please visit:

www.poac.co.nz/ferinject

www.poac.co.nz/zoledronate

www.poac.co.nz/larc

www.poac.co.nz/aub

If you have any questions, please contact:
Deanna Williams, POAC Service Manager
E: deannaw@easthealth.co.nz
Ferinject IV Iron InfusionAclasta Infusion (Counties Manukau only)LARC - JadelleLARC - IUCDAUB Pipelle Biopsy
AucklandCounties ManukauWaitemata
Organisation Name*
Contact Person*

First NameLast Name
Contact Person Email*
Physical Address*

Street Address

Suburb

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (00) 000-0000.
Email address for receipt of referrals*
Should be Empty: