Get Halswell Health

This guide provides a comprehensive walkthrough for users looking to complete the Halswell Health patient enrolment form online. Following these clear steps will ensure that you accurately fill out each section of the form.

Follow the steps to complete your Halswell Health enrolment form online.

1. Click the ‘Get Form’ button to access the patient enrolment form and open it in your preferred document editor.
2. Begin by filling out the patient information section. Enter the doctor you are enrolling with, your chart number, surname, first name(s), and your preferred name. It’s important to also provide your date of birth in the format shown (___/___/___). Choose the appropriate title (Mr, Mrs, Ms, Miss, Mast) and enter your maiden name if applicable.
3. Indicate your gender by selecting 'Male' or 'Female'. Include your occupation and, if known, your National Health Index (NHI) number. Provide details about your employer and their address or phone number.
4. Respond to the question regarding whether you have a Community Services Card (CSC) or High User Health Card (HUHC). If yes, remember to show the card to reception.
5. Fill out your contact details, including both your physical and postal address (if different). Make sure to include specific street addresses, suburb, city, and postcode, avoiding PO Boxes. Also, provide your home, work, and cell phone numbers, along with your email address.
6. Decide if you agree to be contacted via text on your cell phone for communication with Halswell Health.
7. In the ethnicity section, indicate which ethnic group(s) apply to you by marking up to three options. If your ethnicity is not listed, please specify.
8. For next of kin details, input the name, contact number, and relationship to the patient. Follow this by providing emergency contact details who are different from your next of kin.
9. Confirm your understanding of the transfer of records. If you agree, indicate your agreement to Halswell Health obtaining your records from your previous practice.
10. Answer the questions regarding your New Zealand citizenship status and provide information on your country of birth. If applicable, reference the criteria for enrolling if you are not a New Zealand citizen.
11. Review the statement about ongoing healthcare services with the practice and your rights regarding enrolment eligibility. Ensure that you provide proof of your eligibility if required.
12. Read and agree to the Health Information Privacy Statement and the Terms of Trade. You will need to sign and date the form.
13. Finally, save changes to your completed form. You can also download, print, or share the document as needed.

Complete your enrolment form online today for a seamless healthcare experience.