Given Name

    Title (Mr, Mrs, Miss, Master)


    MaleFemaleGender DiverseOther

    Enrolment Eligibility
    I am eligible to Enrol in Compass PHO. I choose to use this practice as my regular and on-going provider of general practice/GP/first level primary health care services. I am eligible and entitled to Enrol because I am residing permanently in New Zealand and I am a New Zealand Citizen.

    Please sign below in the space