Request to Join Burwood Health

We’re so pleased you’re interested in becoming a patient at Burwood Health!

Please note that this is not an enrolment form. Filling in this request form is the first step, and it lets us check whether we’re able to accept you as a patient under our enrolment criteria.

To be eligible to enrol with us, you need to:

✅ Live within our local catchment area (you may be asked to provide proof of address).


✅ Not be enrolled with another local medical centre, including:

    • New Brighton Medical
    • Shirley Medical
    • Travis Medical
    • The Doctors Marshlands (formerly Marshlands Family Health Centre)
    • QEII Medical
    • Local Doctors Eastcare
    • Whānau Ora (Pages Road)

Submitting this request doesn’t guarantee we can enrol you, but our team will review your details carefully.

You’ll hear back from us via email within 10 working days to let you know the outcome of your request.

Your Privacy Matters to Us

The details you share with us will only be used to assess whether we can enrol you at Burwood Health. We take your privacy seriously and keep all information secure in line with the Privacy Act 2020 and the Health Information Privacy Code 2020.

Your details won’t be shared with anyone else unless required by law. By sending us this form, you’re agreeing to us using this information only for this enrolment request.

 

Request to enrol at Burwood Health

Name(Required)
DD slash MM slash YYYY
Address(Required)
Email(Required)
NZ Citizen(Required)
Permanent Resident Visa(Required)
Work Visa(Required)
CONSENT - I am aware that the information provided above will be used to determine my eligiblity to enrol at Burwood Health(Required)
CONSENT - I am aware that Burwood Health has specific criteria for enrolment and if my details do not meet these I will be not be offered enrolment(Required)
CONSENT - I am aware that if I am offered enrolment at Burwood Health that I will need to complete the enrolment form within 4 weeks of receiving(Required)
CONSENT - I am aware that this is not an enrolment form and that I will not be enrolled at Burwood Health upon completion of this form(Required)