Measles in NZ

There are current cases of measles in Aotearoa New Zealand. Make sure tamariki and the whole whānau have had 2 doses of the MMR vaccine. Find out more

Please note this form is only to be used for Canterbury-based clients. Please use the separate forms for South Canterbury or Dunedin-based clients.

Referrer's responsibility

Note: Referrals are allocated once a fortnight. Clients will be notified by email within 14 working days from receipt of referral.

Mother's details

Details of baby and other children

Partner's details

Referral/assessment details

Please tick if any of the following are present and provide details in the box below

*If the client is involved with another specialist mental health service, the referral will be declined

Referrer's Details