Uruuruwhenua Hauora - Referral Service - Uruuruwhenua Referral

Referrer Details

Provider Details
Contact Details
Address
Physical Address
Postal Address

Client Details

Personal Details
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Contact Details
Address
Residential Address
Postal Address

Referral Details

Referral Details

To safeguard the privacy of our whānau, please keep referral information brief. Our Kaimahi will reach out if more information is required.

Emergency Contact Details
Consent Statement

If a 3rd party by submitting this referral, I can confirm I have received consent from the whānau member directly, or under the legal provisions of the Information Sharing Act for Uruuruwhenua Health Inc. to hold and process the information provided for the purpose of managing the referral and related services. We will retain the data securely and use it only as necessary to fulfil this purpose, in accordance with our privacy policy. Whānau have the right to withdraw their consent at any time, and we will ensure that their data is handled with the utmost care and in compliance with New Zealand Privacy Act 2020.

If an individual by submitting this referral, you consent to Uruuruwhenua Health Inc. holding and processing the information provided for the purpose of managing your referral and related services. We will retain your data securely and use it only as necessary to fulfil this purpose, in accordance with our privacy policy. Your information may be shared with relevant parties as required, either with your explicit consent or under the legal provisions of the Information Sharing Act. You have the right to withdraw your consent at any time, and we will ensure that your data is handled with the utmost care and in compliance with New Zealand Privacy Act 2020.