Tākiri Mai Te Ata Whānau Ora Collective Referral Form

First name
Whanau name
Date of birth
Age
Ethnicity
Gender male female
IWI
NHI#
Number of tamariki/mokopuna
Age range 0-4 years
5-10 years
11-17 years
Address
Home phone
Work phone
Mobile phone
Email
Preferred contact number
Current medical centre
Referral date:
Referrer name
Organisation
Referrer Contact Details
Fax nummber
Has whanau been informed? yes no

COLLECTIVE SERVICES

Naku Enei Tamariki (Maori Section) (NET)

Tamariki Details If Applicable
Pepe Due Date
Or Pepe Name
Baby's date of birth
Baby's NHI#
Services required Family Start for vulnerable whānau 0 - 12 months
Awhi Mai Awhi Atu Playgroup 0 - 6 Years
Mobile Playgroup (Wainuiomata only)
Early Intervention - Nurture,Enjoy,Teach 0 - 5 Years
Haakuitanga Haakorotanga - Māori Parenting Programme
Incredible Years Parenting Program 3 - 8 Years
Poipoia Te Mokopuna - Te Ao Maori Programme 0 - 3 Years
He Ao Ki Tua Strengthening Literacy and Maths for 3 - 8 Years
Puawai Māmā Support Group 0 - 5 Years

Tu Kotahi Maori Asthma Trust

Services required Asthma
COPD
Bronchiolitis
Other Respiratory

Mana Wahine

Services required Cervical Screening
Breast Screening
Kia ora e te Iwi Living Well with Cancer - Māori Cancer Support

Kokiri Marae Keriana Olsen Trust

Services required Whānau Ora Social Services
Wainuiomata Whānau Support Services
Tihei Rangatahi - Programmes for Wainuiomata Rangatahi
Kāti te Tūkino - Supporting Violence Free Whānau
Tama Tū Tama Ora - Mens Non Violence Group
Te Ao Marama - Wahine Anger Management Group
Kaumatua Support Services
Whanau Ora Hapū Māmā
Sexual Health Clinics
Outreach Diabetes Service
Outreach Immunisation Service
Child Car Seat Rental Scheme

Kokiri Marae Maori Women's Refuge

Servies required Counselling Therapy
Whakaoho Wairua Living without Violence Programme
24 Hour Crisis Line - 04 566 5025
Safe House Support

Tākiri Mai te Ata Services

Services required Whānau Ora Navigator Services
Regional Stop Smoking Services

Whai Oranga O Te Iwi Health Centre

Services required Comprehensive Primary Health Services
Community Dental Service for Adults
& FREE Adolescent Dental Services for aged 13 - 18 years.

Wainuiomata Marae - Ph: 5648395

Services required A wonderful venue and facilities
Koha Shed
Karanga and Paepae Classes
Ora Tika- Rongoa Maori

Reason for Referral

Reason
How soon is intervention required?
First name
Whanau name
Date of birth
Age
Ethnicity
Gender
male female
IWI
NHI#
Number of tamariki/mokopuna
Age range
0-4 years
5-10 years
11-17 years
Address
Home phone
Work phone
Mobile phone
Email
Preferred contact number
Current medical centre
Referral date:
Referrer name
Organisation
Referrer Contact Details
Fax nummber
Has whanau been informed?
yes no

COLLECTIVE SERVICES

Naku Enei Tamariki (Maori Section) (NET)

Tamariki Details If Applicable
Pepe Due Date
Or Pepe Name
Baby's date of birth
Baby's NHI#
Services required
Family Start for vulnerable whānau 0 - 12 months
Awhi Mai Awhi Atu Playgroup 0 - 6 Years
Mobile Playgroup (Wainuiomata only)
Early Intervention - Nurture,Enjoy,Teach 0 - 5 Years
Haakuitanga Haakorotanga - Māori Parenting Programme
Incredible Years Parenting Program 3 - 8 Years
Poipoia Te Mokopuna - Te Ao Maori Programme 0 - 3 Years
He Ao Ki Tua Strengthening Literacy and Maths for 3 - 8 Years
Puawai Māmā Support Group 0 - 5 Years

Tu Kotahi Maori Asthma Trust

Services required
Asthma
COPD
Bronchiolitis
Other Respiratory

Mana Wahine

Services required
Cervical Screening
Breast Screening
Kia ora e te Iwi Living Well with Cancer - Māori Cancer Support

Kokiri Marae Keriana Olsen Trust

Services required
Whānau Ora Social Services
Wainuiomata Whānau Support Services
Tihei Rangatahi - Programmes for Wainuiomata Rangatahi
Kāti te Tūkino - Supporting Violence Free Whānau
Tama Tū Tama Ora - Mens Non Violence Group
Te Ao Marama - Wahine Anger Management Group
Kaumatua Support Services
Whanau Ora Hapū Māmā
Sexual Health Clinics
Outreach Diabetes Service
Outreach Immunisation Service
Child Car Seat Rental Scheme

Kokiri Marae Maori Women's Refuge

Servies required
Counselling Therapy
Whakaoho Wairua Living without Violence Programme
24 Hour Crisis Line - 04 566 5025
Safe House Support

Tākiri Mai te Ata Services

Services required
Whānau Ora Navigator Services
Regional Stop Smoking Services

Whai Oranga O Te Iwi Health Centre

Services required
Comprehensive Primary Health Services
Community Dental Service for Adults
& FREE Adolescent Dental Services for aged 13 - 18 years.

Wainuiomata Marae - Ph: 5648395

Services required
A wonderful venue and facilities
Koha Shed
Karanga and Paepae Classes
Ora Tika- Rongoa Maori

Reason for Referral

Reason
How soon is intervention required?

Takiri Mai


Phone 0508 KOKIRI - takirimaiteata@kokiri-hauora.org.nz

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