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Oral Health Service: Free oral health services for tamariki — Northland

Kia ora, you can enrol your child for free oral health services from birth to 17 years of age. You can complete the online form to enrol your child.

Enrol your child online

You can withdraw consent for your tamaiti to receive oral health care at any time. You will need to contact us if any information changes.

This form can enrol up to 2 children. Any additional children would need to be entered on a new form.

Mōhiohio Tamaiti / Taiohi | Your child's information

Ingoa Tuatahi | First name

Also known as

Ingoa Whānau | Family name

Rā Whānau | Date of birth

Place of birth

Provide a copy of your visa or permit, and photo identification.

Current school

Names of other children in the family that are already enrolled

Matua | Information about the parent or legal guardian

Name of the parent or legal guardian of the child

Relationship to the child

Address

Postal address (if different to above)

Phone (mobile is preferred as a text will be sent for appointment reminders)

Email address

Alternative contact name

Alternative contact's phone number

Whakaaetanga | Consent

Name of the person consenting

Relationship to the child

I am consenting to the following

Regular dental examinations

Dental X-rays

Fluoride Varnish

Fissure Sealants

Additional children

Do you have additional children you would like to enrol?

Yes

Conditions and treatments

Immunisations

Keeping well

Pregnancy and maternity

Mental wellbeing

Locations

Services