If you require urgent medical attention, please call 111 immediately. This form is not monitored for emergencies and should not be used for urgent care.

This form is for people in Canterbury who have had an accident and need wound care, continence care, or stomal care funded by ACC. You can use this form to refer yourself directly to Nurse Maude for non-urgent care, either at home or at our clinic. 

Please note that this service is only available within the Canterbury region.

Referrer Details

Please complete this section only if you are referring on behalf of someone else.

Details of the person who requires medical care.

Referral Details

Declaration