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Remuera Medical Centre

Apply to Enrol at Remuera Medical Centre

Please complete the form below to apply to enrol as a patient at Remuera Medical Centre.

You will need the following to upload to us:

  • A scanned picture of your passport,
  • If you are not a NZ Citizen we also need a copy of your Visa,

We will need your full name, date of birth, address and previous GP details.

If you wish to enrol multiple family members, you will need to complete these steps for each person separately.

Your details


Your entitlement to healthcare funding


Previous GP

We will contact your previous GP to get your records transferred to us.

I understand that my name will be removed from the register of my previous general practice.

Your emergency contacts


Enrolment Consent

I wish to enrol/re-enrol with this general practice. I understand that:

  • This provider is a member of a Primary Health Organisation (PHO) and I have been informed of the implications of enrolment with this PHO.
  • I cannot enrol with more than one practice at the same time.
  • This practice is funded on the basis of its enrolled register and information on this form will be sent to the Health Funding Organisation.
  • I agree to the practice sharing my health information with other health providers involved in my healthcare.
  • My information may be used for practice screening & recall programmes, and practice quality activities and audit.
  • I have read this document and understand and agree that I am now an enrolled patient of this practice.
  • I have been given and read the Health Information Privacy Statement

Please draw your signature here: