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Te Oranga Activities Referral

To enrol in our programmes, whaiora must be enrolled with Te Kākano Hauora. If you would like to make a referral to Te Kākano Hauora, please click here.

Kia ora! What would you like to do today?

Important

Before you continue, please complete the following checklist. If you are referring someone else, please ensure you (or their Support Worker) complete this checklist with them. If you have any questions or need help completing this form, please Contact Us. 

Referrer Details

Client Details

Gender

Referral Information

If you are referring someone else, is the person aware of this referral?
Programmes: (Please be aware that some programme numbers are limited.)
Upload File

GP Details

Enrolled with GP?

Emergency Contact Details

Support Worker Details

Te Hā Waitaha

Smokefree status:
If interested in smokefree support, are you pregnant?

Consent

Ka pai! Thank you for your referral.

We will contact you as soon as possible.

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