Patient Forms

Aclasta Referral

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.

Aclasta GP Referral Form

Automatic payments

Complete and return to your bank to arrange an automatic payment of existing and future medical costs.

Automatic Payment Form

New patients

Dr Tama Blaiklock and Dr Alex Stapleton is currently the only doctor taking on new patients, however, if you are wanting to enrol with another doctor this will be by request only and assessed case by case.

To enrol with us please complete and return to Hamilton East Medical Centre.

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

Tama Blaiklock is currently the only doctor taking on new patients. however, if you are wanting to enrol with another doctor this will be by request only and assessed case by case.

Please complete and return to Hamilton East Medical Centre.

Transfer of Notes Form

Health Information Privacy Statement

Travel questionnaire

Complete this form before coming to visit our Travel Doctor.

Travel Questionairre

PADI Dive Medical

Please complete and return before making your Dive Medical appointment.

PADI dive medical form