Accessable - assessor identification form
Thank you for your interest in registering for our new aSAP platform. Please note, you must be authorised to access this system:
- For northern region DHB staff and other assessors ordering for people through a DHB/MOH contract, you must be an accredited assessor, or have service accreditation verified by your DHB
- For ACC assessors, you must work for an authorised provider or a provider that contracts to an authorised provider – this information must be submitted for verification.

If you work for more than one provider, we require a unique email address to register you against each provider. Please complete as many forms as you need to register under each provider.

Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
MOH AEA Number (DHB contracts)
Organisation (that holds the ACC or MOH contract) *
Branch/Department Name
Contact number - Landline
example : 091234567
Contact number - Mobile
example : 0123456789
Delivery Address - Company Name
Delivery Address - Building/Department
Delivery Address - Street
Delivery Address - Suburb
Delivery Address - City
Delivery Address - Post Code
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy