ACC Client Form

Ngātahi are a registered vendor with ACC to provide Rongoā Māori services for approved ACC clients seeking rehabilitation alongside treatment for injury.

If you are interested in receiving Rongoā Māori through Ngātahi as a tool for your rehabilitation, fill in the form below and submit. You will be emailed once your submission has been processed.

There is a $30 initial consult fee required on arrival to your appointment.

Name

First Name

Last Name

Date Of Birth (DD/MM/YYY)

MM

DD

YYYY

ACC Number

Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any previous injuries?

Do you have any medical conditions?

Message

ACC Client Form

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