MedOnline - online GP telehealth for New Zealand

First Name

Family Name

Gender Male Female Non-binary

Date of Birth

Ethnicity

Email

Mobile Phone Number

Address

Suburb

Town

Postcode

Eligibility for funded NZ services

(It is okay if you are not "eligible", it just affects the price you pay at the pharmacy for medications, and the cost of lab tests.)

I am NOT ELIGIBLE but need a doctors appointment please I am a New Zealand citizen (includes Cook Is, Niue & Tokelau) I hold a resident visa or permanent resident visa I am an Australian citizen/PR and intend to stay for at least 2 years I have a work visa/permit and can show that I am able to be here for at least 2 years Other...

Do you have a Community Services Card (CSC)?

No Yes - I have a CSC

My local registered GP Surgery is:

Consents and confidentiality

I consent to my data being matched against the Ministry of Health NHI systems, and agree to the Health Information Privacy Statement I consent to the use of the NZ Shared Health Data Record (optional - and has not been built by the Ministry of Health yet! - but should enable a snapshot of your notes, diagenoses and medication to visible to urgent care, ED and GPs) I consent to my registered GP receiving a notification of these consultations (optional). (As one of the oldest telehealth services, we know many of our patients do not want their local GP informed; that is why you are coming to us - so please be reassured it is ok not to tick this box!)