Register as a new client with
Blind Low Vision NZ

Please complete this registration form if you or the person you are referring is a first time client. If you are not sure, please call us on 0800 24 33 33 to verify.

If you are an existing client and would like to request services, please call us on 0800 24 33 33.

Prerequisites



Sorry, but we can not proceed with your registration.

Thanks for connecting with us. We are New Zealand’s main provider of vision rehabilitation, which provides practical and emotional support for people with vision loss.

In order to determine which services and potential funding you may be eligible for, we need information about your eye health, including your most recent eye report.

If you don’t have a copy, we suggest you contact your eye health practitioner to obtain this. You can ask your practitioner to make an online ophthalmic referral on your behalf. This will provide us with the information we need to begin your registration.

You can also call 0800 24 33 33 to speak to one of our helpful staff, who will be able to provide you with more information and assistance.

Sorry, but we can not proceed with your referral

Thanks for connecting with us. We are New Zealand’s main provider of vision rehabilitation, which provides practical and emotional support for people with vision loss.

In order to determine which services and potential funding the person you are referring may be eligible for, we need information about their eye health, including their most recent eye report.

If you don’t have a copy, we suggest you or the person your are referring contact their eye health practitioner to obtain this. You can ask their practitioner to make an online ophthalmic referral on their behalf. This will provide us with the information we need to begin your registration.

You can also call 0800 24 33 33 to speak to one of our helpful staff, who will be able to provide you with more information and assistance.

Important note: We can still proceed with your referral, however, could you please provide the reason why this request has not been discussed? Please note, we will be contacting the person being referred to obtain additional information and confirm their request for service.



Important note: We can still proceed with your request for services, however, need more information from you. For example, Blind Low Vision NZ will need to be notified of the date of the accident, type of injury and if possible your ACC claim number and ACC Case Manager details. If you already know these details, please enter them into the fields below, otherwise, please contact your GP or eye health specialist to make a claim with ACC.
Important note: We can still proceed with your request for services, however, need more information from the person you are referring. For example, Blind Low Vision NZ will need to be notified of the date of the accident, type of injury and if possible their ACC claim number and ACC Case Manager details. If you already know these details, please enter them into the fields below, otherwise, the person you are referring needs to contact their GP or eye health specialist to make a claim with ACC.





What is your name?







The following information is required for the Ministry of Health and helps us check eligibility for services, what means of funding is available and which services may be helpful.



If you cannot find your ethnicity in the picklist, then please select "Other" and specify in the next field "Other Ethnicity".




Who would you like to refer to Blind Low Vision NZ?

The name of the person you are referring.





The following information is required for the Ministry of Health and helps us check eligibility for services, what means of funding is available and which services may be helpful.




If you cannot find your ethnicity in the picklist, then please select "Other" and specify in the next field "Other Ethnicity".




How can we get in touch with you?







How can we get in touch with them?

The contact information of the person you are referring.






What is your current Physical address?










What is their current Physical address?










Eye Health

In order to process your request for services, we need some information about your eye health, including your most recent eye report and details of your eye health practitioner. Please provide as much information as you're able to.
If you know the contact information of the eye health practitioner for the person you're referring, we may contact them for information regarding their condition. 







Please upload the eye report by selecting "Choose File" below. Alternatively, you can email it through as an attachment to registrations@blindlowvision.org.nz


Important note: if you only have a paper copy of your most recent eye report, please fax it to 09 355 6919 as soon as possible. Alternatively, you can scan it or take a picture and email it through as an attachment to registrations@blindlowvision.org.nz

Please note that we require your eye report within 30 days after you submitted this form, in order to continue with your registration. If we don't receive the document within that time period, your application will automatically be withdrawn.

If you need more information and assistance, please call 0800 24 33 33 to speak to one of our helpful staff.

Important note: if you only have a paper copy of their most recent eye report, please fax it to 09 355 6919 as soon as possible. Alternatively, you can scan it or take a picture and email it through as an attachment to registrations@blindlowvision.org.nz.

Please note that we require an eye report of the person your are referring within 30 days after you submitted this form, in order to continue with their registration. If we don't receive the document within that time period, the application will automatically be withdrawn.

If you need more information and assistance, please call 0800 24 33 33 to speak to one of our helpful staff.

Alternative contact / next of kin












What is your contact information?

The name and contact details of the referring person.










Before you submit your request...


In many areas we have community based committees, local support groups and other contacts who run a variety of activities for clients in their area.

There are Blind Low Vision NZ endorsed organisations that represent the interests of people who are blind/deafblind or have low vision. They offer peer support, advocacy and social activities.