Lakes | Healthy Homes Initiative

Lakes - 20 Degrees Referral Form

Refer to 20 Degrees below if you are in the Lakes rohe. Don't stress if you're on a border of Lakes, just refer and we can work out the best providers for you :)

Reason for enquiry*

Whānau first name*

Whānau last name*

Whānau address* (if living outside of the Bay of Plenty, please instead go to https://www.hhi.org.nz/want-an-hhi-visit/)

Whānau town/area*

Whānau phone*

Whānau email

Whānau preferred method of communication

Whānau living tenure*

Whānau has a child living in the home*

Someone in the home has a Community Services Card (CSC)*

Comments/Concerns about whare (if you are referring a client, please include your contact information and organisation below)*

How did you hear about us?*

Address

Thank you for reaching out. Someone from Health Homes Service will be in touch about this referral.

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