Enrol Online or In-Person at Gore Health

Enrolment Options

1. Enrol Online (on this page)
Fast, secure, and convenient — complete our online enrolment form from any device.
Just scroll down and fill in the form below.

2. Enrol In Person
Prefer to enrol at the clinic? Visit us and fill out a physical form on-site, or download and bring the completed forms with you.

It is important that you allow 3-4 weeks for this enrolment to be processed at which time you will be contacted by Gore Health to have a new patient onboarding appointment with one of our nurses.

Please ensure that you have enough supply of your regular medication to continue with in the meantime.

Clinic Address:
9 Birch Lane, Gore 9710, New Zealand
Phone: 03 209 3022

Please attach your identification documents (see below).

What You’ll Need

To enrol, you must provide documents proving your eligibility for publicly funded healthcare in New Zealand.

Primary Identification (choose one):

New Zealand Passport
New Zealand Birth Certificate (including Cook Islands, Niue, or Tokelau)
New Zealand Certificate of Citizenship
Descent Registration Certificate
Evidence of receiving a social security benefit (excluding emergency benefits)

Supporting Documents (bring two, including one with a photo):

Driver’s licence, student ID, or other photo ID
A recent utility bill, bank statement, or another document confirming your current address

Who Can Enrol?

You must be permanently residing in New Zealand (intending to stay for at least 183 days over the next 12 months) and meet one of the following criteria:

New Zealand citizen
New Zealand resident or permanent resident visa holder
Australian citizen or permanent resident staying in New Zealand for at least two consecutive years
Work visa holder eligible to stay in New Zealand for two years or more (including prior permits)
Interim visa holder (if previously eligible)
Refugee, protected person, or victim of trafficking
Dependant under 18 in the care of an eligible parent or guardian
Dependant aged 18–19 who was dependent on a valid visa holder as of 15 April 2011
Special international students or scholars, including:
- NZ Aid Programme students receiving Official Development Assistance
- Ministry of Education Foreign Language Teaching Assistants
- Commonwealth Scholarship recipients under the Commonwealth Scholarship and Fellowship Fund

Benefits of Enrolling

Subsidised general practice visits and prescription costs
Continuity of care with our medical team
Access to ManageMyHealth – securely view your health records and lab results online
Streamlined referrals to specialist and hospital services

Enrolment Period

Your enrolment with Gore Health remains valid for up to three years without a consultation or confirmed contact.
To ensure your enrolment stays active, we recommend reconfirming it through a signed form or an auditable communication (e.g. a documented phone call).

After three years of inactivity, you may be removed from the Enrolment Register.

Leaving or Changing Providers

You may dis-enrol from Gore Health at any time.
We may also terminate enrolment if:

There is a breakdown in the patient-provider relationship
Records show that Gore Health is no longer your regular provider

We will notify you and help you find a new healthcare provider if needed.

Privacy and Information Sharing

Your information is protected under the Privacy Act 2020 and associated Health Information Privacy Codes.
It is only shared with healthcare professionals directly involved in your care, with your confidentiality always respected.

Provider or PHO Changes

If Gore Health changes its provider or PHO affiliation, your enrolment status will not be affected.
We will notify you of any changes during your next appointment or through clinic updates.

Your Responsibilities

To help us provide the best care, please:

Provide accurate information when enrolling
Inform us promptly if your contact or personal details change
Maintain communication with the clinic to keep your enrolment active

Need Help?

If you have questions about the enrolment process or your eligibility, get in touch — we’re here to help.
Phone: 03 209 3022

Enrolment Form

Your details

Residential address

Postal address (if different to residential address)

Emergency contact details

Employer details

Transfer of records

In order to get the best care possible, I agree to the Practice obtaining my records from my previous Doctor. I also understand that I will be removed from their practice register.

Community Services Card

High User Health Card

Smoking information

National Screening Programmes

My declaration of entitlement and eligibility

The definition of residing permanently in NZ is that you intend to be resident in New Zealand for at least 183 days in the next 12 months

If you are not a New Zealand citizen, please select which eligibility criteria applies to you

Clear selection

My agreement to the enrolment process (Parent or Caregiver to sign if you are under 16 years of age)

I intend to use this practice as my regular and on-going provider of general practice / GP / health care services.

I understand that by enrolling with Gore Health Centre I will be included in the enrolled population of WellSouth Primary Health Network, and my name address and other identification details will be included on the Practice, PHO and National Enrolment Service Registers. I understand that if I visit another health care provider where I am not enrolled I may be charged a higher fee.

I have been given information about the benefits and implications of enrolment and the services this practice and PHO provides along with the PHO's name and contact details.

I have read and I agree with the Use of Health Information Statement. The information I have provided on the Enrolment Form will be used to determine eligibility to receive publicly-funded services. Information may be compared with other government agencies, but only when permitted under the Privacy Act.

I understand that the Practice participates in a national survey about people's health care experience and how their overall care is managed. Taking part is voluntary and all responses will be anonymous. I can decline the survey or opt out of the survey by informing the Practice. The survey provides important information that is used to improve health services.

I understand that the practice may share my health information between healthcare providers using HealthOne, a secure system for storing electronic patient records and that all information is kept confidential and checks are in place to monitor all access.

I understand that further information on HealthOne is available from the practice on request.

I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.

Authority to sign

An authority has the legal right to sign for another person if for some reason they are unable to consent on their own behalf.