Self-Referral Forms

Please note that PASS (formerly our Green Prescription Service) is no longer accepting self-referrals. 

If you would like access to these services, please make an appointment with your primary care practice to discuss your needs. Your healthcare practitioner will be able to make this referral providing us with all relevant information.

Please remember that you have access to a Health Coach (HC) and/or Health Improvement Practitioner (HIP) within your practice also. These are FREE appointments. HIPs or HCs can support you to make a plan and provide you with information and tools to manage your health better. 

Nutrition Self Referral Form

The West Coast Health Dietitian Service accepts self-referrals. It’s simple – all you need to do is fill in this form and a dietitian will be in touch.

Take advantage of this free service today.

Breastfeeding Advocate Referral Form

Breastfeeding may be natural, but that doesn’t mean it comes naturally. There are plenty of scenarios that can make breastfeeding harder and getting the right information and support is vital.

If you need help working through a breastfeeding challenge or have questions about anything related to breastfeeding, our Breastfeeding Advocate will be able to help you.

The West Coast Health Breastfeeding Advocate accepts self-referrals. It’s simple – all you have to do is fill in this form and our breastfeeding advocate will be in touch.

Take advantage of this free service today.

For more information about the Breastfeeding Advocate, click here

Youth-Mental Health Referral Form

We provide Brief Intervention Counselling for mild to moderate mental health problems, not only for adults but for youth as well, and it’s a FREE service.

Good health includes physical, emotional, mental, social, and spiritual wellbeing.  

This programme can assist rangatahi with emotional and mental fitness. We are available to cover areas coast wide from Karamea to Haast.  

You can self-refer to our programme, or can be referred by GP’s, nurses, family members or school teachers.

Please note: This online referral form is for referring youth only (12 -24 years).