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Event Medical Services booking form

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Event Medical Services booking form

Thanks for your interest in booking our Event Medical Services.

Please fill in the form below and we'll be in touch soon with a free, no obligation quote.

Request a free quote

Name of event

Date of event - if your event lasts more than 1 day, please enter the first day you require our services *REQUIRED

If your event lasts more than 1 day, please let us know how many days you require our services

Have we done this event before? If yes, what was the exact date *REQUIRED

Event street address and access roads

Time you need us on site *REQUIRED

Expected finish time *REQUIRED

Description of event *REQUIRED

Number of participants *REQUIRED

Number of spectators

Name of person to report to on arrival and phone number

Please let us know of any risk factors including: moving vehicles, machinery, animals, etc.? Physical endurance event? Contact sport? Excessive heat or cold? Terrain? Alcohol or drugs? Previous incidents?

Any special instructions for our staff?

Your name and company / organisation

Your email address *REQUIRED

Your contact number

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Mobile Number (Optional)

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Street Address (Optional)

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Your Rights & More info

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Your Rights

As our patient, and under the Health and Disability Commissioner’s Code of Rights, you have the right to:

Be treated with respect
Be fully informed
Freedom from discrimination, coercion, harassment and exploitation
dignity and independence
Services of an appropriate standard
Effective communication
Be fully informed
Make an informed choice and give informed consent
Support
Respect of teaching or research
Complain

If we don’t respect these, let us know and we’ll do everything we can to put it right.

Support in the process

If you need support or help with making a complaint, you can contact the office of the Health and Disability Commissioner and ask for an advocate.

www.hdc.org.nz
0800 555 050

Do you have a (pick one)? Compliment Suggestion Complaint

Are you contacting us on behalf of someone else? Yes No

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Mobile Number (Optional)

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Street Address (Optional)

Please describe your experience (be sure to include the date, time and location) {{contactForm.fieldErrors.Message}}

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In an emergency dial

To contact Wellington Free Ambulance

General Inquiries

Please contact us to discuss other options for being in touch.

Phone: (04) 499 99 09
Fax: (04) 499 3777
Address: 19 Davis Street, Thorndon 6011
Postal address: PO Box 601, Wellington 6140
Media enquiries: 021 348 571

In an emergency dial

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Did you know
We are proudly the only emergency ambulance service for Greater Wellington & Wairarapa