Enrol with The Fono Medical Clinic

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Make The Fono your family GP

Enrolling with The Fono Medical gives you full access to everything we have to offer, including, virtual consults, affordable care and access to The Fono’s community and wrap-around services.

This also means that you will agree to transfer your medical records from your current GP to The Fono’s Medical Clinic.

You will need:

5 minutes of your time
Your proof of ID i.e. passport or birth certificate
Your parent/guardian or a designated signatory to sign and give permission to the enrolment process, if you are under the age of 16 or need a designated signatory.

*All fields marked are mandatory

Choose your medical clinic

*Which clinic would you like to enrol with?

*All fields marked are mandatory

Legal name

Your name must match your passport details

*First name

Middle name(s)

*Last name

Preferred name

Maiden name

Birth details

*Date of birth

*Place of birth

*Country of birth

Gender

*Please select one of the options

Male

Female

Gender diverse

Ethnicity

*Please select up to 3 options

New Zealand European

Māori

Iwi

Select...

Samoan

Cook Islands Maori

Tongan

Niuean

Chinese

Indian

Other ethnicity

Select...

e.g. Dutch, Japanese, Tokelauan etc...

Community cards

I have a Community Service Card

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*All fields marked are mandatory

Transfer of records

To get the best care possible, I give permission to have my medical records transferred from my previous doctor to The Fono Medical clinic. I also understand that I will be removed from their practice register.

Yes, please request my records

Register for our Patient Portal

Securely view your health records online and more using our Patient Portal.

Yes, register me for the Patient Portal

Agreement to the enrolment process

I intend to use this practice as my regular and ongoing provider of general practice/GP/ health care services.

I understand that by enrolling with The Fono, I will be included in the enrolled population with the Primary Health Organaisation (PHO) this practice belongs 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 implication of enrolment and the services this practice and PHO provides along with the PHO’s name and contact details.

I have read and I agree with 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 when permitted under the Privacy Act.

I agree to inform The Fono of any changes in my contact details and entitlement and/or eligibility to be enrolled.

*Yes, I agree to The Fono’s enrolment process

Designated signature

If you’re under 16 you will need a parent/caregiver to sign on your behalf

*Who is signing this form?

Myself

Parent / Caregiver / Guardian

Designated signature

Sign your name here

I am unable to sign

Without a signature you would be a Casual / Visitor, you will not be eligible for the funded services. You must provide a signature to become an Enrolled patient.

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Enrol with The Fono Medical Clinic

Make The Fono your family GP

Choose your medical clinic

Legal name

Birth details

Gender

Ethnicity

Community cards

Residential address

Postal address

My contact details

Emergency contact

Transfer of records

Register for our Patient Portal

Agreement to the enrolment process

Make The Fono your family GP

Eligibility

About you

Contact details

Proof of ID

Declaration