HealthZone Medical
Clinic Enrolment Application
Welcome to online enrolment
Enrol🔵Clinic is our online new enrolment form at HealthZone Medical.
Enrol🔵Clinic helps those eliglble to receive care at HealthZone Medical, with funded cheaper doctor visits and other benefits, by completing a quick registration form to enrol online.
You can also enrol up to 4 eligible dependants younger than 16 yrs at the same time.👶🧑👦👧
Fields marked with a * are required entry fields that must be completed
Start >>Declaration of Eligilibity
I am entitled to enrol because I am residing permanently** in New Zealand.
(** = Residing permanently in NZ means that you intend to be resident in New Zealand for at least 183 days in the next 12 months).
Dependant children under 16 years old (optional)
You can choose to enrol your dependant children under 16 years old with HealthZone Medical as long as you are their parent or legal guardian. You may be asked for documentation to confirm that you have the authority for any children you enrol. This evidence could be a birth certificate, adoption papers, guardianship papers or NZ Family Court confirmation.
Add Dependant children SKIP >>Please select your current New Zealand Eligibility statement
Proof of New Zealand Eligibility documentation
To receive government subsidised doctor visits, you need to present evidence of eligibility, as per the statement/options below
I confirm that, if requested, I can provide proof of my eligibility, and:
Upload photo proof or snap a photo with your phone camera
Please provide a photo of your proof of eligibility with your form.
If you are a permanent resident, this is your documentation or correspondence from NZ Immigration.
Otherwise, this would be your Passport or New Zealand Birth Certificate.
Transfer of Medical Records
In order to obtain the best health care possible, the practice needs my health previous records.
By completing details below, I hereby agree to the practice obtaining my records from my current/previous doctor and their practice/clinic.
I also understand that I will be removed from that practice register.
My agreement to the enrolment process
NB. Parent or Caregiver to sign if you are under 16 years
- I intend to use this practice, HealthZone Medical, as my regular and ongoing provider of general practice/ GP / health care services.
- I understand that by enrolling with HealthZone Medical I will be included in the enrolled population of HealthZone Medical’s Primary Health Organisation (PHO), which is Everywhere PHO, and that my name address and other identification details will be included on the Practice, PHO and National Enrolment Service Registers.
- I understand that if I visit another health care provider where I am not enrolled I may be charged a higher fee.
- I have been given information about the benefits and implications of enrolment and the services that HealthZone Medical and the PHO provide along with the PHO’s name and contact details (https://www.comprehensivecare.co.nz/why-enrol/).
- I have read and I understand the Use of Health Information Statement. The information I have provided on the Enrolment Form will be used to determine eligibility to receive publicly-funded services. Information may be compared with other government agencies, but only as permitted under the Privacy Act.
- I understand that the Practice participates in a national survey about people’s health care experience and how their overall care is managed. Taking part is voluntary and all responses will be anonymous. I can decline the survey or opt out of the survey by informing the Practice. The survey provides important information that is used to improve health services.
- I agree to inform the practice,HealthZone Medical, of any changes in my contact details and entitlement and/or eligibility to be enrolled.
Submission being sent
Your enrolment is being submitted to practice HealthZone Medical.
Please wait for this to finish and for final confirmation.
