Join the waiting list

Name of primary contact person for your household

Number of people including children (total) wishing to enrol from your household (must all be at same address)

Address that you CURRENTLY live at

Current Medical Centre that you are enrolled at (list all if more than one for all people wishing to enrol)

Email address for main contact

Mobile number for main contact person

Ethnicities of those wishing to enrol

I CURRENTLY live within the designated zone

I am NOT already enrolled at a medical centre within 15 km of Rolleston Medical Centre. (West Melton/Darfield Medical, Phoenix, Templeton Medical, Rolleston Central Health, Lincoln/Wigram/Prebbleton We Care, Lincoln Medical)

I understand that by submitting this information, I consent to be added to a waiting list at Rolleston Medical and that submission will not enrol me in the practice

I understand that If I do not meet the eligibility criteria, my waitlist submission will be declined.

I understand I won’t be able to choose which doctor I am enrolled with. I will be allocated a doctor with space available for registrations.

If your submission is declined we will advise by email or text.

If you are eligible, you will be contacted by email or text to advise next steps.

Join the waiting list

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