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Service Provider Profile Information

* indicates a mandatory field.

PLEASE ONLY add your service if you are a RELEVANT service provider to the AREA.

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Service / Organisation Name *

Organisation Description *

Organisation Mission Statement

Physical Address (Level or Building) *

Street Address (Street Number and Name) *

Suburb *

City / Town *

Phone (Landline) *

Phone (Freephone)

Phone (After Hours)

Phone (Mobile)

Fax

Email *

Website

Twitter URL

Facebook URL

Upload your business logo

You may upload a JPG, PNG or GIF image, maximum size of 2mb. We recommend a size of 500 pixels in width (by a max height of 500 pixels).

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Upload up to 5 photos to accompany your profile

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Who Funds You?

Who Are You Accountable to?

Type of Organisation *

Non-Government Organisation

Government Agency / Department

Trust

Incorporated Society

School

Voluntary Organisation

Support / Service Group

Maori / Iwi Provider

Marae

Pacifc Island Provider

Refugee / Migrant

Informal Group

Other

What Specific Services Do You Provide? *

Manager or Coordinator's Full Name *

Target Group Demographics Age Range *

Ages 0 - 4

Ages 5 - 10

Ages 11 - 15

Ages 16 - 24

Ages 25 - 55

Ages 55+

All ages

Target Group Ethnicity *

Pacifc Island

Maori

Asian

European

All

Other

Please Specify

Target Group Gender *

Male

Female

Non-specific

Service Provision Days of Operation *

For example: Monday - Friday 9am - 5pm, Saturday 10am - 2pm, Sunday closed

Is there a Cost to your Service? *

Yes

No

Subsidised

How Much (please give a range of costs for your services)

Are you Accepting New Clients or Referrals?

Yes

No

What Information is Required for a Referral? *

Link to Referral Form Currently in Use

Any Further Information?

Date Information Was Provided *

Content provided by *

Content provider Phone (DDI) *

Content provider Email *

source

Keyword

I'm looking for info about:

Service
Healthy Living

Location

Profession

Category

Organisation type

Helpful links

We don't have all the answers. See the list below for links to other helpful resources.

QuitLine
www.quitline.co.nz

Whanganui DHB
www.wdhb.org.nz

Ministry of Health
www.health.govt.nz

Want to be added as a service provider?

If you’re a provider who operates within the Whanganui DHB region, you can register with ManageMe. Click here to submit information about you, or your business.

Register with ManageMe

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