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If you or the person you are referring is eligible for support from Connections & Funding, please complete the referral form below (previously called a “Needs Assessment” or “NASC” referral).
If you’re not sure if you or someone else is eligible, view the eligibility criteria here.
Referrals can be made via email using the forms below or with our online referral form.
If this is your first time working with us, please ensure your doctor or specialist completes the confirmation of diagnosis form (see below). Please note that we cannot proceed with a referral without a completed confirmation of diagnosis.
Online referral form
Downloads:
Once completed email your form/s to referrals@yourwaykiaroha.nz
You can also email any questions to referrals@yourwaykiaroha.nz or call us on 0800 758 700 between 8:30am and 4:00pm weekdays.
Who can make a referral?
You can apply yourself using our self-referral form. We can accept referrals on your behalf from any of the following people. They will need to complete the referring someone else form.
- a whānau/family member
- a friend
- a carer
- a disability support organisation
- a doctor or health professional.
Anyone making a referral must have the permission of the person referred. Parents or caregivers can refer children and young people aged under 18 using the self-referral form.
If you make a referral and it is declined, you can ask us to reconsider this. This is called a dispute. Please contact referrals@yourwaykiaroha.nz or complaints@yourwaykiaroha.nz.