Registration Form

Thank you for booking an appointment with Dermatology Hawke’s Bay. As a new patient, we require you to fill out the registration form below. This will ensure we have all the information we need prior to your first appointment. 


  • I understand that my Personal information will be used in accordance with the Health Information Privacy Code 2020. For more information, see Dermatology Hawke’s Bay’s Privacy Statement.
  • I am aware that if it is clinically indicated, I may be offered additional procedures during the visit which will incur additional costs. These will be explained to me at the time of my appointment.
  • I agree to pay in full at the time of my appointment if this is not covered by my insurance. See Dermatology Hawke’s Bay’s Terms and Conditions for more information about fees and failure to pay. 
  • I confirm that I have read and agree to Dermatology Hawke’s Bay’s Terms and Conditions.
  • When using any health or disability service in New Zealand you are protected by a Code of Rights. View the Code and your rights here.
  • The Health and Disability Commissioner has produced a video called ‘Respecting Your Rights!’ to inform patients of their rights when it comes to health and disability care. Click here to watch the video.

By completing the registration form I confirm that I have read and agree to the information provided above.