Welcome to Registration for NZDSOS's Health Help Line 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 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 Please click on New Zealand to bring up other country options. Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belau Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda São Tomé and Príncipe Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (Dutch part) Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) United States (US) United States (US) Minor Outlying Islands United States (US) Virgin Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 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 Usual GP Name and Clinic Usual Pharmacy Name and Address 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. Email Email Submit
