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Oamaru Pacific Island Community Group Inc.

Referral Form

Referral Form

Greetings, Talofa, Talofa lava, Malo e lelei, Kia orana, Fakalofa lahi atu, Taloha Ni, Tena koe

Please complete all the sections of this form and email to info@oamarupacific.nz or hana@oamarupacific.nz.
You will receive acknowledgement via email that your referral has been received. If you have any queries please contact Hana Halalele, General Manager (027)415 2129.

Service(s) you are referring for (these services are provided free of charge):(Required)

Client Details

Name(Required)
DD slash MM slash YYYY
Gender(Required)
Address
Residency Status(Required)

Referrer Details

Do you have consent from your Client /are they aware of your referral?(Required)