Te Hunga Whaikaha Total Mobility Support Agency referral form

Te Hunga Whaikaha Total Mobility Support Agency referral form

 

Te Hunga Whaikaha Total Mobility subsidises taxis for disabled people who are unable to independently use public transport some or all of the time.

Read more about Te Hunga Whaikaha Total Mobility.(external link)

If you found this form while looking for the self registration form, please follow the below link.

Te Hunga Whaikaha Total Mobility form(external link)

Te Hunga Whaikaha Total Mobility is available to residents of the greater Wellington region only. For details of other Total Mobility providers across Aotearoa, see below.

Total Mobility across Aotearoa(external link)

This form is for approved third-party referrals only. Once received, Metlink will contact the customer directly within 4 working days to start the application process.

Referrer Details

Let's get started

Eligibility information

Please confirm:

If the customer does not have a permanent illness or impairment, they may not qualify for Te Hunga Whaikaha Total Mobility. Please contact Metlink to discuss the eligibility criteria.

 

If the customer is able to use public transport independently and safely all of the time, they may not qualify for Te Hunga Whaikaha Total Mobility. Please contact Metlink to discuss the eligibility criteria.

 

Customer information

Extra information

Other valuable information you would like Metlink to know about this registration for Te Hunga Whaikaha Total Mobility. e.g, discharge date from hospital, potential health and safety concerns at home, contact support person to arrange assessment etc.

Alternative contact person

Does the customer want to provide details for an alternative contact person?

Home address

Postal address

Customer's preferred contact method *
During the customer's Te Hunga Whaikaha Total Mobility assessment, their assessor will ask them a few questions. Will they require an interpreter?

Privacy and Consent

Read the Metlink Privacy Statement(external link)

Please confirm: *
Please confirm: *
Thank you for your support.

We will contact the customer directly once this referral has been processed. We aim to make contact with the customer within 4 working days.

Last published: Wednesday, 12 June 2024 at 9:33 pm