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Making a Referral to Bee Healthy Regional Dental Service

If child has had an accident and has an injury to their teeth or mouth, please advise parent to contact a private practice dentist to book a dental exam and register injury with ACC. Some dentist may charge a ACC co-payment, so they will need to check this when booking. Bee Healthy is not an ACC provider so is unable to provide care for injury-related dental issues.
If child is in pain, please call 0800 TALK TEETH (0800 825 583) directly to make a relief of pain appointment.
If you see any of the following or have other concerns, please complete the following referral form below.

Chalky, white spots/patches
Yellow/brown discolouration
Clearly visible cavities
Red inflamed gums
Abscess

Bee Healthy Referral Form:

Child's details
Has the child had a dental appointment with Bee Healthy before?
Yes

No, the child is enrolled with Bee Healthy but has not had their first dental exam yet.

No, the child is not enrolled with Bee Healthy (usually the case if child is not born in the Greater Wellington Region). Please complete the online enrolment form at www.beehealthy.org.nz/dental-care-for-children/enrol-online/ before the completing referral form.
Child's first name *
Child's last name *
Date of birth (DD/MM/YY) *
NHI number *
Ethnicity *
Address (street, suburb, city & post code) *
Parent or Guardian Contact Details
Parent/Guardian's full name *
Relationship to child *
Contact phone number/s *
Email address
Alternative contact (name, relationship to child, contact phone number, email address)
Referral Information
Outline nature of referral * 0/500 Words
Optional attachement 1
Optional attachement 2
Referrer's Contact Details
Referrer's Name *
Organisation *
Referrer's contact phone number *
Referrer's email address *
To send a copy of referral form to yourself (the referrer), please enter your email address below
To send a copy of referral form to the PARENT, please enter their email address below