Patient Registration

Tauranga Eye Specialists

Patient Registration Form

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Step 1 of 5

General Information 

Date of Birth:
Address:
Is your postal address different from the one provided above?
Text appointment reminder:
Preferred method of communication:
Ethnicity:
Do you have an activated EPOA for health and welfare in place?

Alternative Contact:
(e.g. parent, caregiver, next of kin, guardian...)