Green Prescription Self Referral Application

Are you a Community Services Card holder?
What type of support are you interested in?

In submitting this form I agree to my details being used for the purposes of participating in the Green Prescription programme. The information will only be accessed by necessary Sport Wellington staff. I understand my data will be held securely and will not be distributed to third parties, with the exception of my nominated medical centre who will be informed of my progress on the programme.

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