Enrol online

Eligible to Enrol

Children with New Zealand citizenship or relevant resident status are entitled to free oral health care until their 18th birthday.
Please email your documents to: dental@huttvalleydhb.org.nz stating you are enrolling your child on the Bee Healthy Website. Enrolment can take up to 4 weeks to process.
To prevent delays in enrolling your child(ren) into Bee Healthy Regional Dental Service, please supply the relevant documents to support your enrolment request.

1. Is your child a New Zealand Citizen

Yes - Please provide: NZ Birth Certificate or NZ Passport or NZ Certificate of Citizenship, if no move to question 2

2. Are you a New Zealand Resident

Yes - Please provide: Childs Immigration Resident E-Documentation or Child`s Passport with Resident Visa, if no, move to question 3

3. Do you have a relevant Work Visa for 24 months and over, if no, move to question 4

Yes - Please provide: Parent`s Work Visa E-Documentation and Child`s Birth Certificate and Immigration E-Documentation with passport

4. Other - please state 0/500 Words

Personal details of your child

Child's First Name *

Child's Family Name *

Gender

Male

Female

Child's Date of Birth *

Street Address *

Suburb *

City *

Post Code *

NHI Number (3 letter, 4 digit number in your child's Well Child booklet)

Child's Ethnicity 1 *

Child's Ethnicity 2 (optional)

Child's Ethnicity 3 (optional)

School your child attends or will attend *

Prefered Clinic *

Siblings Already Enrolled (include name and birth date) 0/500 Words

Parents or Guardian Contact Details

Your First Name *

Your Family Name *

Relationship to child

Home Phone

Mobile Phone

Email *

Alternative contact person (enter full name)

Relationship to child

Home phone

Mobile Phone

Child's Medical History

Name of Doctor or Medical Practice *

Does your child have any medical conditions?

Yes

No

If yes, please list 0/500 Words

Consent

This consent will remain valid while your child continues to receive dental care provided by Bee Healthy Regional Dental Service on a mobile clinic or at a dental hub. Consent can be withdrawn at any time by contacting Bee Healthy: 0800TALKTE(ETH) - 0800 82 55 83

Please select

I AGREE for my child to be enrolled with Bee Healthy Regional Dental Service for regular dental check-ups

I AGREE for my child to receive fluoride varnish application and teeth cleaning.

I AGREE to the use of dental x-rays for detecting decay and othrconditions when indicated.

I understand that should any preventative coating, fillings or extractions be required, my consent for these will be requested before these are provided.

Eligible to Enrol

Personal details of your child

Parents or Guardian Contact Details

Child's Medical History

Consent

Dental Care for Children