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  QUICK REFERRAL

  Referral is easy. Please contact us using the form below. We will respond within 2 days setting out the options for referral, including whether the patient is eligible to be covered by any DHB funding, according to our contracts.

  Referrer:

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  Referrers Address:

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  Referrers Email:

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  Patient Name:

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  Patient NHI Number:

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  Patient DOB: Sex M/F: MF

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  Ethnicity:

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  Main Diagnosis:

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  Why the patient needs QE:

  Rheumatology Specialist
  Physiotherapy
  Occupational Therapy
  Orthotics
  Psych/Counselling
  Spa
  

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  Comorbilities, allergies:

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  Additional Info:

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Purchase a Voucher

To purchase a Spa at QE Gift Voucher, simply select from the options below and click on the Buy Voucher button. A PayPal form will open, prompting you to fill out some details. To purchase a voucher you must be a member of PayPal. You can sign up to PayPal HERE.

Once you have filled out the simple PayPal form, you will receive an email confirmation and QE Health will mail your Gift Voucher to you.

Select a Voucher 30 Min Aix, Therapeutic or Relaxation Massage $65.00 60 Min Aix, Therapeutic or Relaxation Massage $115.00 30 Min Specialty Massage $70.00 60 Min Specialty Massage $125.00 90 Min Specialty Massage $150.00 Rachel Pool for 2 $20.00 Mud Bath Single $65.00 Mud Bath Double $85.00 $50 Voucher $50.00 $100 Voucher $100.00 $150 Voucher $150.00 $200 Voucher $200.00 Voucher Recipient