Become a member - Aurum Health

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Thank you for choosing Aurum Health for relationship-led healthcare across New Zealand.

Please complete this brief form to begin your Aurum Membership. You will be asked to complete some basic personal details, select between Gold or Silver membership. At any point, you can call us for support. Please note that Aurum can only provide services to people aged 18 and over.

Once you've completed the form, one of our Relationship Managers will be in touch to review and finalise your application with you. Or, if you prefer, we would be delighted to support you over the phone.

Your information is handled in line with our Client Privacy and Data Care Policy .

Full legal name*

First Middle Last

Gender identity*

Date of Birth*

DD slash MM slash YYYY

Email*

Enter Email Confirm Email

Mobile phone*

NHI (National Health Identification) number

If you know your NHI, please add it here.

Current residential address*

Street Address Address Line 2 City Post Code

Roughly how long have you lived here?*

less than 6 months

between 6 and 12 months

more than a year

Previous residential address

Street Address Address Line 2 City Post Code

Are you currently enrolled or registered with a general practice in New Zealand?

You do not need to change your GP to use Aurum Health services. By default, we will not contact your existing GP or share information with them without your consent. We ask this question solely to provide you with a smooth clinical service.

Yes

Unsure

Prefer not to say

Current GP name and/or general practice (if known)

Current GP practice address

Street Address Address Line 2 City ZIP / Postal Code

Preferred contact method*

Phone

Text

Best time to contact you?*

To follow up on your membership application, please let us know the best time to contact you.

Morning (8am to 12pm)

Afternoon (12pm to 4pm)

Evening (5pm to 6pm)

Any time (8am to 6pm)

Would you like to use WhatsApp?*

If you would like to use WhatsApp to message Aurum in the future to manage appointments or requests, please confirm here. You will receive a confirmation WhatsApp message from us, asking you to confirm this option.

Yes, I would like to use WhatsApp

No, I do not want to use WhatsApp

Membership Selection

Membership Product*

Gold Membership

Silver Membership

Membership Type*

Note that all clients must be aged 18 or over. If you wish to nominate a membership for someone aged under 18, you must contact Aurum Health. We cannot process an online form for anyone under the age of 18.

Single Membership

Joint Membership

Nominated Member's Name*

First Middle Last

Nominated Member's Email*

This email must be unique to the nominated member. You can not use the same email as the main member.

Enter Email Confirm Email

Nominated Member's Date of Birth*

DD slash MM slash YYYY

Nominated Member's Phone*

Nominated Member's Residential Address*

Same as primary member

Street Address Address Line 2 City State / Province / Region Post Code

Billing Frequency*

If you would like to pay annually, you will receive a 5% discount, unless you have a specific discount code to apply at payment.

Monthly

Annually

Our preferred payment method is by direct bank transfer. We do accept payments via debit or credit cards; however, a 3.5% surcharge is added due to third-party processing fees.

No matter which method you choose to pay, we will email you a link to complete your preferred payment option. In all cases, a 5% discount is applied if you pay annually unless you have a discount code.

Please select how you would like to pay*

Credit / Debit Card

Direct Bank Transfer

Discount Code

If you have a discount code, please let us know here. You will receive a message to confirm the code is valid and it will be applied. The details will be emailed in the payment instructions.

The discount code "Coast20" is valid and will be applied to your payment details. Please check your confirmation email.

I confirm that I have read and agree to the Gold Membership terms and conditions*

Sample Gold Membership Agreement

Client Data Care Policy

Scope of Care Policy

Fees and Cancellation Policy

Fair Use Policy

I confirm that I have read and agree to the Silver Membership terms and conditions*

Sample Silver Membership Agreement

Client Data Care Policy

Scope of Care Policy

Fees and Cancellation Policy

Aurum's Newsletter

We would like to send you (and if applicable your nominated member) our newsletters from time to time. Our emails are carefully crafted to be informative and interesting. As part of Aurum's commitment to providing high-quality healthcare information, we will not send you spam. You can also unsubscribe at any time. If you would like to receive emails, please check the box.

I/we would like to receive the Aurum newsletters