Bay of Plenty feedback form

Use this form to provide feedback about your experience with a Hospital in the Bay of Plenty.

What matters to you is important to us. Your feedback helps us improve our services.

Fields with an asterisk (*) are required.

Your feedback

Date your feedback refers to (if known)

Name

National Health Index Number (NHI) number (if known)

Phone

Which ethnic group do you belong to: (tick the boxes that apply to you)

New Zealand European

Māori

Samoan

Cook Islands Māori

Tongan

Niuean

Chinese

Indian

Other ethnicity (please state, e.g., Dutch, Japanese, Tokelauan)

Age range

Iwi

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