Enrol with The Fono Medical Clinic

View this in:

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?

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

*All fields marked are mandatory

*Do you live in New Zealand permanently?

I intend to live in New Zealand for at least 183 days (6 months) in the next 12 months

*Are you a New Zealand citizen?

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

*All fields marked are mandatory

Legal name

Your name must match your passport details

Birth details

Gender

*Please select one of the options

Ethnicity

*Please select up to 3 options


Select...

Select...

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

Community cards

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

*All fields marked are mandatory

Residential address

    Postal address

    Is your mailing address the same as above?

    My contact details

    Please fill in at least one of the following

    Emergency contact

    This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

    *All fields marked are mandatory

    *Please select your proof of ID

    Upload documents

    Upload your passport or birth certificate

    PNG, JPG, PDF, TIFF

    This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

    *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.



    Register for our Patient Portal

    Securely view your health records online and more using our 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.

    Designated signature

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

    *Who is signing this form?

    Designated signature

    Sign your name here

    This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

    Make The Fono your family GP

    Clinic

    Eligibility

    I am not living in NZ permanently

    I am not a NZ citizen

    About you

    Legal name

    Birth Details

    Gender

    Ethnicity

    Community cards

    None

    Contact details

    Address

    ,

    My contact details

    Emergency contact

    Proof of ID

    Declaration

    Transfer of records

    Do not transfer my records

    Register for our Patient Portal

    Do not register

    Agreement to the enrolment process

    Yes, I agree to The Fono’s enrolment process

    Signature details

    24/06/2024

    undefined undefined

    This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.