Contact us

Call Port Nicholson Medical 04-3844315 for an appointment

Port Nicholson Medical
2/61 Taranaki Street
Te Aro
Wellington, 6011
Phone: 04 384 4315
Fax 04 3849196
Email: reception@portnicmed.co.nz

Opening Hours
Monday: 8am - 5:00pm
Tuesday: 8am - 5:00pm
Wednesday: 8am - 5:00pm
Thursday: 8am - 5:00pm
Friday: 8am - 4:30pm
Weekends & Public Holidays : Closed

New Patient Application

If you are interested in becoming a patient at Port Nicholson Medical please fill out this application form and we will assess our capacity to take you on as a new patient.

* Indicates required field

Name *

First

Last

Date of birth *

Email *

Phone number *

Do you have a current GP in Wellington? *

Yes No

What is your current smoking status? *

Current smoker Ex smoker Never smoked

If a current smoker, how may do you smoke per day? *

If an ex-smoker, when did you quit? *

How many standard drinks do you typically consume per week? *

Are you on any regular medications? *

Yes No

If yes, please list with doses and frequency if possible *

Do you have an allergy to any medication or significant reactions to any other substance? *

Yes No

If yes, please list these medications *

Past medical history: please give a brief summary of any long-term or serious health conditions you have or have had including major surgeries *

Family history: do any of your immediate family (parents and siblings) have any serious health conditions including diabetes, heart disease or any type of cancer? Please give details *

Any other queries *

Submit

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Call Port Nicholson Medical 04-3844315 for an appointment

Contact Form

New Patient Application

Port Nicholson Medical

Opening Hours

PAGE lINKS

Call Port Nicholson Medical 04-3844315 for an appointment

Contact Form

New Patient Application

​Port Nicholson Medical

Opening Hours

​PAGE lINKS

Port Nicholson Medical

PAGE lINKS