Enrollment Form

Welcome to Te Kāika!

We're a healthcare provider in Otago that does things differently.

When you become part of the Te Kāika whānau, you'll receive affordable medical services from a team that truly cares about your wellbeing.

Our approach looks after your hauora (well-being) and makes sure that all the care you receive respects your culture and values. We're ready to support you and your family on your healthcare journey in a way that feels right for you.

Personal Details

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Address Details

Contact Details

Employer Details

Transfer of Records

In order to get the best care possible, I agree to the Practice obtaining my records from my previous Doctor. I also understand that I will be removed from their practice register.

Smoking Status

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Declaration of Entitlement and Eligibility

The definition of residing permanently in NZ is that you intend to be resident in New Zealand for at least 183 days in the next 12 months.

(If yes, tick box and proceed to I confirm that, if requested, I can provide proof of my eligibility below)

If you are not a New Zealand citizen please tick which eligibility criteria applies to you (b–j) below:

Choose a file

Upload clear photos or scans of your ID here. If you cannot upload them please bring physical copies to the clinic.

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