When you enrol, you must select one of the following:
If I am Parent or Caregiver to a young person under 16 years of age, I am signing with their agreement or am acting as their signatory authority as they are unable to consent on their own behalf.
I understand that by enrolling with this practice I will be included in the enrolled population of the Primary Health Organisation (PHO) this practice is contracted to, and 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 this practice and PHO provides (find this information here: https://nbph.org.nz/) along with the PHO’s name and contact details (these are: Nelson Bays Primary Health; Phone: 0800 731 317; PO Box 1776 Nelson 7040)
I have read and I agree with the Health Information Privacy Statement (in the next question in this form). 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 when permitted under the Privacy Act.
I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.