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*

Number of people living in the home*

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?*

Hey! Just double check before you hit ‘send’, that you’re kei te pai (okay) with us securely storing and using your information to communicate and assist you with your enquiry.

Address

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

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