Hauora Self-Referral Form
This referral is for:
I want to meet with:
On a scale out of 3, how urgent are you needing the appointment?
1 (Not urgent, I would like to be seen in the next week or so)
2 (I would like to be seen in the next couple of days)
3 (Urgent - see me today please, it is life threatening for me or for someone I know)
How would you like to be contacted?
One of the Hauora team to come and get me from the hapori
If you ticked text or email for the above question, please leave your phone number or email address below
If it feels ok to you, please write a short explanation of why you would like to meet with one of the Hauora team members
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This form was created inside of Haeata Community Campus.