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Enrol you and your family

By enrolling with us, you and your family can visit either of our two clinics, 136 Queens Road, Panmure, Auckland 1072 or 5 Waimahia Avenue, Weymouth, Auckland 2103.


To enrol, you must complete the application form in less than five minutes, and there is no fee. If you are not a New Zealand citizen, you will only need your passport and the relevant visa.

Enrolment form

Select an option
Is the patient 18 or over?
I give permission for my existing GP to transfer my patient notes
I agree to receive Email / SMS comms and participate in surveys
Smoking Status
Would you like support to quit?

Next of Kin

Medical information & eligibility



I intend to use Pasefika Family Health Care as my regular and ongoing provider of general practice / GP / First Level primary health care services.

I am eligible to enrol because:

Proof of Eligibility - Your passport plus the relevant Visa if you are not a NZ Citizen

Upload File

Enrolment Agreement

My agreement to the enrolment process (NB Parent or caregiver to sign if you are under 16 years). I choose to enrol with this practice as my regular and ongoing provider of general practice / GP / First Level primary health care services.


  • I understand that by enrolling with this practice I will be enrolled with the Primary Health Organisation (PHO) this practice belongs to, and my name address and other identification details will be included on both the Practice and the PHO Enrolment Register.

  • I understand that if I visit another provider where I am not enrolled I may be charged a higher fee.

  • I have been given information about the benefits and implications of enrolment with the PHO, and their contact details. I have read and understood the requirements of enrolling with one PHO and choose Pasefika Family Health Group PHO to be my PHO.

  • I have read and I agree with the Health Information Privacy Statement.

  • I agree to inform the practice of any changes in my eligibility.

  • I authorise Pasefika Family Health Group to pass on parts of my health information to the Ministry Of Health.

  • I understand that relevant health information may be forwarded to other health professionals involved in my care.

  • I understand that my health information is accessible by all members of the primary care team and can be accessed at any Pasefika Family Health Group practice so that continuity of care is facilitated through a shared health record.

  • I understand that all members of the primary health care team have signed employment contracts containing confidentiality clauses or have signed confidentiality agreements and have completed privacy training so that my personal health information is kept confidential.

  • I understand that certain information in my daily clinical records can be made confidential to one GP only if required.

  • I also understand that it is my right under the Health Information Privacy Code 1994 to ask to see my personal or Health Information held by the doctor. I can ask for it to be corrected if it is wrong.

  • I understand that if I choose to see another doctor I will register at that practice as a Casual Patient, and if I see a GP outside of Pasefika Family Health Group practices frequently, I may be dis-enrolled from the Pasefika Family Health Group practices.

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