Green Prescription Self Referral Application

Are you a Community Services Card holder?
What type of support are you interested in?
Do you have a COVID-19 vaccination pass?

In submitting this form I agree to my details being used for the purposes of participating in the Green Prescription programme. The information will only be accessed by necessary Nuku Ora staff. I understand my data will be held securely and will not be distributed to third parties, with the exception of my nominated medical centre who will be informed of my progress on the programme. Please contact us if you have any questions regarding the collection and use of your information.

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