CHILD AND ADOLESCENT ORAL HEALTH REGISTRATION FORM 2025

1. Click ‘Get Form’ to open the CHILD AND ADOLESCENT ORAL HEALTH REGISTRATION FORM in the editor.
2. Begin by entering the child's name in the designated fields for Family/Whanau and First/Ingoa. Ensure accuracy as this information is crucial for identification.
3. Fill in the child's Date of Birth and select their gender by checking either Male or Female.
4. Indicate the child's ethnicity and confirm if they are a NZ Resident by selecting Yes or No.
5. Provide the child’s NHI number and any Iwi/Hapu affiliation if applicable, followed by details of their Well Child Provider and Doctor.
6. If your child has received previous dental care, please specify where in the provided space.
7. Enter Parent/Legal Guardian names, address, daytime phone number, mobile number, and email address accurately.
8. Sign and date the form in the designated area to validate your submission.
9. Complete alternative contact details if necessary, including another name, address, phone numbers, and any other children in the household.
10. Finally, ensure that any health professional's details are filled out correctly for follow-up purposes.

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