Call our reception on (09) 638 6040 *protected email* Complete the below form to request an appointment: Request an Appointment Name * First Last * Last Email * Phone * Address Address Address Address City City Region Region Post Code Post Code Date of Birth * Ethnicity * Do you know the first day of your last menstrual period (LMP) Yes No First day of your last menstrual period (LMP) * Appointment type Abortion Enquiry Contraception Enquiry Contraception Type IUD Jadelle Service required Insert Remove Replace Can you feel strings? Yes No Can you feel strings? Yes No CONFIRMATION OF HEALTH CARE ELIGIBILITY Please upload the required documents at the time of your enquiry to avoid delays in processing your request. New Zealand Passport Drop a file here or click to upload Choose File Maximum file size: 104.86MB Foreign Passport & Visa Drop a file here or click to upload Choose File Maximum file size: 104.86MB Referred By Please selectSelfDoctorOther Referrer Name Captcha Submit If you are human, leave this field blank.
