About Us

Visiting Patients

Please call us on 03 443 0710 to make an appointment. You will be directed to this visiting patient information form to complete your details prior to your appointment time.

Title(Required)

Title: Other

Surname(Required)

First Name(Required)

Date of Birth(Required)

Ethnicity(Required)

Ethnicity: Other

Home address(Required)

Street Address City ZIP / Postal Code Country

Wanaka address(Required)

Mobile phone(Required)

Email(Required)

Residency status(Required)

Residency status: Other

Employer details for ACC

Employer name

Employer Address

Occupation

Emergency contact

Name

Phone number

Relationship to you

WE REQUIRE A BASE FEE PRE-PAYMENT PRIOR TO YOUR CONSULTATION

• For base fee costs please see sign at reception.
• If any further charges apply these will be added post consultation and be payable before you leave.

I understand that:
• Payment is expected at the time of consultation.
• I am liable to pay for services provided by Wanaka Medical, including consult charges, procedure charges, lab fees and material charges where applicable.
• Costs are displayed on the waiting room noticeboard or are available on request.
• An account fee will be added if I fail to pay at the time of treatment.
• All costs incurred in the collection of overdue accounts by our debt recovery service will be payable by the debtor.

HEALTH INFORMATION:

I consent to Wanaka Medical collecting and storing personal and health information shared during my visit and that Wanaka Medical will use that information to provide appropriate care. I understand that under NZ privacy laws my doctor may share health information with other health professionals who are directly involved in my care.

Opening Hours

Visiting Patients

WE REQUIRE A BASE FEE PRE-PAYMENT PRIOR TO YOUR CONSULTATION

HEALTH INFORMATION:

Wanaka Medical Centre

Menu

Contact Us

Opening Hours