Get Download The Referral Form - Taikura Trust - Adsa Org

Filling out the Download The Referral Form for Taikura Trust is a straightforward process designed to ensure that your referral is accurate and complete. This guide will provide clear instructions to help you navigate each section of the form, ensuring that your information is submitted correctly.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to download the Referral Form and open it in your preferred document editor.
2. Begin by entering your surname in the designated field. This helps identify you accurately.
3. Next, fill in your first name, followed by your ethnicity in the given spaces.
4. Provide your complete address, ensuring that you include all relevant details.
5. Indicate your gender by selecting either ‘Male’ or ‘Female’.
6. Input your date of birth (D.O.B.) and National Health Index (NHI) number in the specified fields.
7. If applicable, fill in your Community Services Card number along with its expiry date.
8. List your contact numbers, including home, mobile, and work phone numbers.
9. Provide the name and phone number of your General Practitioner.
10. If you have a Person who is your Next of Kin (NOK) or caregiver, please enter their name and address along with contact numbers.
11. Indicate your relationship to the NOK or caregiver in the designated field.
12. Respond to the question of New Zealand Permanent Residency by checking the applicable box.
13. Confirm whether consent for referral has been given by the client by selecting yes or no.
14. If you have any cultural or interpreter requirements, please indicate this by selecting yes or no.
15. Indicate if you are an existing client of Taikura Trust.
16. In the section for diagnosis and disability details, provide the necessary information and confirm any required supporting documentation.
17. Provide a reason for the referral in the space provided.
18. Fill in the name and designation of the person making the referral, along with their contact number.
19. Finally, ensure that the form is signed and dated before submission.
20. Once all fields are completed, save the changes to your document and download, print, or share the completed form as needed.

Complete the referral form online today to ensure your needs are met.