For referrers
Auckland: patient referral PDF download
Please download and complete the 'Orthotic Patient Referral Form' on this page for Auckland Region patient referrals.
Submitting your form
Send your completed form to aklorthreferrals@pw.co.nz.
Peke Waihanga Orthotic Service staff will process your form and contact you.
Download Instructions
To save this PDF to your computer or device using Chrome, Firefox or Microsoft Edge:
- Click on the link below
- Open the file with a PDF reader (e.g. Adobe Acrobat) to complete it
If you are using Internet Explorer, please click on the link below then manually save the file.
Click to download
OS Orthotic Referral Form October 2022 Interactive (PDF, 113 KB)Orthotic referrals from General Practice must be submitted via the BPAC referral system. All other referrers, please fill in the form below.