For referrers

I am making this referral from:

Auckland: patient referral PDF download

Please download and complete the 'Orthotic Patient Referral Form' on this page for Auckland Region patient referrals.


If you are unsure about this referral, please call 0508 678 255 for advice.


Submitting your form

Send your completed form to

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:

  1. Click on the link below 
  2. 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)

: patient referral form

diagnosis and treatment details
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