This for is for medical practitioners who wish to refer patients to the Hamilton East Medical Centre Infusion Centre for Aclasta. Please download, complete this form and return to Hamilton East Medical Centre.
Complete and return to your bank to arrange an automatic payment of existing and future medical costs.
To enrol with us please complete and return to Hamilton East Medical Centre.
Please note that we are unable to accept scanned, photocopied or emailed versions of the enrolment form.
If you were born outside of New Zealand, please provide proof of residency or a working visa endorsement.
Australian citizen’s or Australian permanent resident’s also need to provide proof that they intend to stay in New Zealand for at least 2 consecutive years.
Once all of the originals have been sighted and verified by our reception staff, we can then book you in for your first appointment.
Transferring medical records from another doctor/clinic
Please complete and return to Hamilton East Medical Centre.
Health Information Privacy Statement
Complete this form before coming to visit our Travel Doctor.
PADI Dive Medical
Please complete and return before making your Dive Medical appointment.