Opthalmology Appointment Enquiry – Te Whatu Ora

Patient Firstname*

Patient Surname*

Patient NHI if known or Date of Birth*

Preferred Phone Number *

Email This is optional, to allow us to send an email confirming receipt of your enquiry

Clinic Location (Preferred)

Whangārei

Kaitaia

Bay of Islands

Dargaville

Time of Day (Preferred)

Morning

Afternoon

Anytime

Any further comments