Enrolment

QuayMed is OPEN for patient enrolments for ALL patients living OR working/within the area defined on the map below. We also accept dependent children from existing enrolled patients.

WHAT DOES IT MEAN?

Enrolling with Quaymed means that you are choosing us to be your general practitioner. This means that you will come and see a doctor here at QuayMed for all your medical care unless you have an urgent problem and the clinic is closed. See Out of Hours care.
You can only enroll for general practice services if you are a NZ citizen, permanent resident or hold a continuous visa for more than 2 years duration.

Once enrolled with QuayMed the government will partially subsidise the cost of your visit. This funding is allocated once every 3 months so there may be a delay from 6 weeks to 5 months before you are fully enrolled AND funded. Once you are fully funded a reduced consultation fee applies. We are a VERY LOW COST ACCESS practice and the fees for consultations are set out below:-

Why should I enrol?
  • To access very low cost consultations and save $$ on your medical bills;
  • To access a range of other services such as free sexual health consultations, cardiovascular check ups and access to dieticians and specialist nursing services provided by our PHO;
  • To ensure continuity of care with a dedicated team of doctors and nurses.
Why will I NOT be enrolled immediately?
  • In order to activate your enrolment, we need an original signed enrolment form. This is a Ministry of Health requirement
  • Even when you have submitted your form electronically,  you MUST ATTEND THE PRACTICE IN PERSON to sign the form.
  • Please bring along your passport to show eligibility if you were not born in NZ.
  • When you are at the practice, you will need to see the Nurse for a quick new Patient Health Check. Once you have completed ALL these steps,your enrollment is complete. Funding for low cost care follows between 6-18 weeks later.
Registration & Enrolment Form

Please enter as much information as possible to assist us with your enrolment.

All fields marked with an asterisk * are required.

Title *:
First Name *:
Surname *:
If married, maiden name:
Gender *: MaleFemale
Date of birth *:
Suburb / city *:
Residential address *:
Post code:
Phone home:
Phone mobile:
Phone work:
Email *:
Occupation:
Ethnicity:
If other, please state country of birth:
NHI number (if known):
High user of Health or Community Services Card?: YesNo
Were you born in NZ?: YesNo
Are you a NZ permanent resident?: YesNo
Are you on a 2 year work visa?:
Please bring passport to clinic to show eligibility
YesNo
Name of contact in case of emergency:
Phone:
Relationship:

I understand that the Practice may need to disclose parts of my health information to the Health Funding Authority to monitor healthcare provision for audit and funding purposes. Any information provided by me will be confidential in accordance with the health Information Privacy Code. Fees are payable on the day of consult. Any overdue invoices may result in information being passed to credit agencies.

There are lots of benefits in being permanently enrolled for GP services at this practice. Once you are fully funded these include very low cost GP's consultation and access to a wide range of services such as counselling, patient self management, sexual health etc.

Would you like a QuayMed doctor to be your usual GP, and have your medical notes transferred to QuayMed? YesNo
Enrolment Form for Permanent Patients Only

I understand the reasons and implications of being enrolled with you as outlined in the information available for patients. You are my preferred General Medical Services. I give permission for my name to be added to your Enrolment Register. I understand that I can only be enrolled and funded at ONE client at a time in New Zealand. I acknowledge that my previous GP will be informed and my medical notes will be transferred here. By enrolling with this practice, I will be part of your patient population for funding purposes and the Ministry of Health and the Network may access this register for audit purposes. I understand that this practice will be advised and charged a fee if I used subsidised servcies of another practice or primary care facility. I understand that QuayMed will discuss with me if I frequently attend other GP practices.

I understand that the practice is entitled to charge a fee for any health services provided and I agree to pay such costs according to the policy fo the practice at the time of consultation. I will be responsible for any additional costs associated with the collection of overdue and unpaid accounts.

I fully understand all the requirements and agree that I am now an enrolled patient of QuayMed Accident & Medical Clinic.

To know when your funding is coming in, please check with the receptionist.
Please tick this box if you do not wish to receive text messages for results & recalls: No text messages thanks!

I also wish to enrol the following people in my custody who are under the age of 16 years:

  Surname First Name(s) Date of Birth Gender Ethnicity
1
2
3
4

NB: Patients over the age of 16 must complete their own form. Please inform the receptionist if your postal and residential addresses are different.

I authorise QuayMed to request the transfer of my medical records YesNo
Previous GP / Practice Details:

Please tell us some important information about your health. Do not worry if you are unable to complete some of the answers below. Please discuss with the nurse or doctor at your new patient check.

Height:
Weight:
Smoking status:
Year stopped:
For smoker or ex-smoker how many?:
Alcohol average standard units per week?:
Do you have any of the following conditions? DiabetesHeart DiseaseAsthmaEpilepsy
Please list your regular medicines:
Do you have any allergies to any medications?: YesNo
Name of drug:
What happens?:
Women 20-70 yrs
Date of last cervical smear:
Normal: YesNo
Women 20-70 yrs
Date of last mammogram:
Normal: YesNo
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