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Thank you for registering with us, we will be in contact shortly.

There was an error submitting your application, please advise TToH to resolve.

Client Registration Form

Please fill out the form below and associated privacy statement and consent form and one of our staff will be in touch with you.

1. What Services are you interested in? ^

Please let us know what services you are interested in.


If you have urgent concerns for your health, please call 111 for an ambulance or head to the Emergency Dept at Hastings Hospital

2. I am completing this for a client ^

If you are filling this form out for yourself you can ignore this section.

3. Client Details ^
4. Register other household members ^

Fill these out if you have household members you would like to be registered.

5. Emergency Contact ^

Please provide someone we can contact in case of emergency

Error: The form was not submitted successfully, please contact TToH with the following error code :
 
 
0800 TAIWHENUA
06 871 5350Or contact us here.

 

HAUORA HERETAUNGA
Phone 06 8715352
Fax 06 8715353
Email medical@ttoh.iwi.nz

 

PLEASE PROVIDE FEEDBACK 

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