For referrers

I am making this referral from:

Auckland: patient referral PDF download

Please download and complete the 'Orthotic Patient Referral Form' on this page for Auckland Region patient referrals.

 

If you are unsure about this referral, please call 0508 678 255 for advice.

  

Submitting your form

Send your completed form to aklorthreferrals@pw.co.nz

Peke Waihanga Orthotic Service staff will process your form and contact you.

 

Download Instructions

To save this PDF to your computer or device using Chrome, Firefox or Microsoft Edge:

  1. Click on the link below 
  2. Open the file with a PDF reader (e.g. Adobe Acrobat) to complete it

 If you are using Internet Explorer, please click on the link below then manually save the file. 

 

Click to download

OS Orthotic Referral Form October 2022 Interactive (PDF, 113 KB)

: patient referral form

diagnosis and treatment details
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Contact Us

Orthotic Service Auckland
0508 678 255 (freephone)
Orthotic Service Waikato
0508 679 245 (freephone)
Orthotic Service Tauranga
0508 267 678 (freephone)
Orthotic Service Canterbury
0508 677 265 (freephone)
Orthotic Service Dunedin
0508 474 474 (freephone)