Refer a patient

We call within one working day.

What is this about?

I want an appointment, or I am referring a patient I would like the free 15-minute phone consultation

Patient details

First name *Enter the patient’s first name

Last name *Enter the patient’s last name

Date of birthHelps us find the patient on the ACC portal

Contact number *Enter a phone number so we can call

Town or suburb *Tell us the town, so we book the right clinic

Funding source * Choose a funding source

Gender

Reason for referral *

Reason for referral and brief history Tell us briefly what this is about

Referral from

Your name

Role

Clinic or practice

Contact email

I understand Kiwi Orthotics will use these details to make contact and arrange an appointment, and that this form is handled as described in the privacy statement.

Send it through

Your referral is ready below. Send it by email, or copy it into your own system.

Send by email

What happens next

We phone the patient to arrange a time.
We book the assessment at a time that suits.
We confirm the funding route before anything is made.

The same orthotist assesses, casts, fits and reviews, so nothing is lost in a handover. Off-the-shelf bracing is usually fitted on the same day, so post-operative and acute referrals do not wait on fabrication.

Please do not attach notes, imaging or wound photographs. Send full clinical information through your usual secure channel once we have made contact.

Prefer to phone? Call 07 242 0957 or email contact@kiwiorthotics.co.nz.

Orthotic assessment, manufacture and fitting across the Waikato