Referrals

To refer whaiora to He Waka Tapu
complete the form below

Please Note:

  • He Waka Tapu does not provide food parcels or accommodation.
  • Please call MSD on 0800559009 if you require these supports

Referrer information

Referrer organisation required
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Referrer phone required
Referrer email required

Client details

Client first name required
Client last name required
Please specify DOB
Gender required
Ethnicity required
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Client address required
Client contact number required
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Preferred contact method required
Medical Practice / GP required

Next of kin

Next of kin name required
Next of kin relationship required
Required
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Reason for referral required
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Please accept the terms & conditions to continue

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