This form is for Year 9-13 Students who would like to request an appointment with one of our Wellness Providers.
Please complete the required answers and Mrs Whatley will be in contact with your appointment details. This will be sent to your school email address.
Please note, for counselling services the assigned counsellor will contact you themselves in relation to an appointment date and time.
Koru Group / Class:
Contact Number so that the Doctor/Nurse/Counsellor make contact with you if needed:
Which Wellness Service would you like to book an appointment with?
Doctor (Friday: 10.30am -12.30pm)
Nurse (Thursday: all day)
Counsellor (Will be confirmed by the assigned counsellor)
Preferred time (Doctor or Nurse)
For counselling appointments, we need to know a brief reason for the request. For example: I'm not sleeping, I'm struggling with....
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This form was created inside of Whangamata Area School.