Registering for Health Help Line

Welcome to Registration for NZDSOS's Health Help Line

If you have any difficulties filling out this form please contact the Health Help Line directly on: [email protected]

I confirm the details I give are true and correct. I have disclosed my true identity and the true purpose of my consultation and I am acting in my capacity as a private citizen. I realise that if I give false information before or during this consultation then no information from before or during this consultation can be used in any way. I understand that my doctor will keep the contents of my consultation confidential and that I agree to do the same.

Your First Name

Your Last Name

Your Preferred Name

Your Date of Birth

If you are having trouble with the date of birth, please type it out here in long form.

Please upload a photo or PDF of your passport page (with visa if applicable) or birth certificate. This is required for Ministry of Health access to blood tests and subsidised medications where appropriate. If you are having trouble with this please contact the NZDSOS Health Helpline or fill out the contact form on the NZDSOS website.

Choose File

Email Address

Phone Number (preferably mobile)

Alternative Phone Number

Address Line 1

Address Line 2

City

Post Code

Country

Name of next of kin to contact in case of emergency

Phone Number of next of kin to contact in case of emergency

Email of next of kin to contact in case of emergency

Do you give us consent to contact your usual GP about changes in treatment and other relevant health information?

Usual GP Name and Clinic

Usual Pharmacy Name and Address

Please let us know what you want help with e.g. vaccine injury, general practice services.

Have you ever had adverse reactions (side effects or allergy) to medication? If so, please describe.

Do you have any medical conditions that you are currently under treatment for?

Are you currently using medication? If so, please list.

Are you taking any supplements? If so, please list.

I understand the fees for the NZDSOS clinic are:

Nurse fee: koha (we suggest $30.00)
Doctor fee for consultation: $95 for 20 minutes
Doctor fee for answering a query through your patient portal (Manage My Health): $20

Please note the clinic is completely private with no government funding. For a full list of fees please see here.

I have read and agree to the Rights, Privacy and Consent commitments.

Welcome to Registration for NZDSOS's Health Help Line

If you have any difficulties filling out this form please contact the Health Help Line directly on: [email protected]

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