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Are you looking for support to return to work in Auckland, Waikato, Hauraki, Rotorua, Taranaki, Wellington or Christchurch? Fill in the form below and we will be in touch. Our funding structure means there is sometimes criteria to access our services – but if we are unable to assist you because of this we may be able to suggest other possibilities.

Workwise also accepts referrals from community mental health providers, GPs, Work and Income, and other support service providers and agencies. To make an enquiry yourself, or make an enquiry on someone’s behalf, please fill in the online form below or download the printable version here and send it to us.

For further information, just get in touch.

Client details
First names:*	Gender: M F
Last name:*	Date of birth:*
Phone number:*	Country of birth:*
Mobile:	New Zealand resident: Yes No
Email:	Ethnicity: NZ European/Pakeha European Maori Pacific Islander, specify: Other, specify:
Region:*
Postal address:
Alternative contact details:

Health / benefit details
NHI number:	Benefit type: Invalids Sickness Unemployment Other
Primary diagnosis:

Clinical support person:
Postal address:
Phone number:
Email:

Work & Income number:
Work & Income case manager details
Name:
Email:
Phone number:
Work & Income service centre:

I (the client), * give consent for any referring agency and Workwise to share information about me. I understand that information will only be given to workers of these two agencies who obey the code of confidentiality of the agencies that they represent. I understand that participation in this initiative is voluntary and that I can withdraw my consent and participation at any time.
	Date:*



Referral agency to complete Please complete if you are a referring agency.
Contact name:	Agency:
Contact email:

* Required fields

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Client details

Health / benefit details

Referral agency to complete