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- Early medical abortion
- Surgical abortion
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  - Contraception cost overview
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Patient referral

HealthLink ID: TURLEYME

hello@thewomensclinic.co.nz

Healthcare Professionals – Patient referral form

If you are a healthcare professional and wish to refer a patient, please complete the below form. We will acknowledge your referral within the next working day and contact the patient.

Email

This field is for validation purposes and should be left unchanged.

Your details

Your first name(Required)

Untitled

Email

I am a*(Required)

Te Whatu Ora region*(Required)

I am referring the patient for a

Date of patient's last period start? Write 'not sure' if unsure

Has the patient had a blood test? *(Required)

Has the patient had a blood test? *

Yes

No

Where was the blood test ordered?

Do you have the results of the patient’s blood test?

Do you have the results of the patient’s blood test?

Yes

No

Upload blood test results:

Upload blood test results:

Max. file size: 1,000 MB.

Has the patient had an ultrasound scan? *(Required)

Has the patient had an ultrasound scan? *

Yes

No

Where was the scan ordered?

Do you have the results of the ultrasound scan?

Do you have the results of the ultrasound scan?

Yes

No

Upload blood test results:

Upload blood test results:

Max. file size: 1,000 MB.

Patient details:

Patient’s first name*(Required)

Patient’s last name*(Required)

Patient’s date of birth* i.e. DD/MM/YYYY(Required)

Untitled(Required)

Patient’s address

Patient’s NHI number

Patients GP Practice name

Patients name of GP

Safe contact details:

Phone number*(Required)

Is it safe to call? *(Required)

Is it safe to call? *

Yes

No

Is it safe to text?(Required)

Is it safe to text?

Yes

No

Is it safe to leave a voice message? *(Required)

Is it safe to leave a voice message? *

Yes

No

Email address

Is it safe to email?

Is it safe to email?

Yes

No

Do you require a discharge summary? *(Required)

Do you require a discharge summary? *

Yes

No

Does the patient have a Community Services Card?*(Required)

Does the patient have a Community Services Card?*

Yes

No

Card number

Expiry date

DD slash MM slash YYYY

Message

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Abortion Options
- Early medical abortion
- Surgical abortion
Contraception Options
Costs
- Abortion Cost
- Contraception Cost
  - Contraception cost overview
FAQ
Get in touch
Request Appointment

From 27 July to 7 August 2026, our hours will be 9:00am–5:00pm while our team undertakes staff training. Please leave a message on 0800 226 784 or email us at hello@thewomensclinic.co.nz

Current patients requiring the after-hours nurse should refer to their patient information sheet..