General enquiries
Request the passcode for the self-referral form or make a general enquiry.
CLINIC PHONE
027 222 0473
CLINIC LOCATION
Paremata,
Porirua 5026,
Wellington
Self-referrals
This self-referral questionnaire is password-protected. Please email us using the contact form on this page.
BEFORE YOU BEGIN:
This questionnaire takes approximately 10-15 mins to complete.
If you are interrupted when filling it in, your completed answers will be stored for up to 15 days.
We are a busy clinic. Once submitted, your questionnaire will be reviewed (current review wait time approx 6 weeks). Once assessed, if your referral is accepted, we’ll be in contact to inform you of the steps to register with Dr Peter’s clinic. Once you are registered, an appointment will be made for you (current wait time is approx 3 months).
Please ensure you have reviewed our Services & Fees prior to completing the questionnaire.
CONFIDENTIALITY
Your privacy matters to us and is a fundamental part of our profession. Any information you share via our website is kept confidential and secure. Your details will not be shared without your permission. If you have any questions, feel free to reach out.
SELF-REFERRAL FORM