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Self Referral

We welcome self-referrals from individuals seeking specialist gastroenterology consultations or private endoscopy procedures.

Please complete the form below. Your responses will help us assess your needs and we will contact you for further information.

First Name

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Last Name

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Date of Birth

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Address

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Phone Number

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Email

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NHI (if known)

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How would you like to be contacted ?

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Reason for Referral

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GP name / GP practice name

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Address

"Thanks for reaching out! We’ll review and get back to you"

Canterbury Endoscopy and Gastroenterology - Main Branding

GET IN TOUCH

Ask for Ginette or Olivia

P. (03) 968 3140
E. info@canterburyendoscopy.co.nz

CLINIC
Level 2, 21 Caledonian Rd, St Albans, Christchurch 8014