Referral Form Please Note: Dr. Paul Smedley is no longer practicing. He has had to retire early on medical grounds. * RequiredName of the Clinician / Clinic / Contact Person*Email Address* Phone Number*Patient's Name*Patient's Date of BirthNHI numberPatient's AddressPatient's Contact Number/s*Patient's Email Address Patient's Preferred Method of ContactHome PhoneCell PhoneEmailComments and reason for patient referral.Please attach any relevant files or fax to 09 486 0159 Drop files here or Accepted file types: pdf, doc, docx, png, jpg.