Te Awhi Rito Referral

He ara tautoko mō ngā māmā, pēpi, me ngā whānau – A pathway of support for māmā, pēpi and whānau.

First and Last Name of māmā (or main caregiver)

Māmā/Caregiver Date of Birth

Phone

Address

Pēpi/tamariki details (if any)

If you are hapū, please let us know how many weeks pregnant you are and when pēpi is due:

What areas would you like support in? Required

In-home support for māmā or pēpi

Antenatal/postnatal education

Navigating services or entitlements

Emotional and mental wellness support

Help with transport or access to appointments

Whānau support (for partner, other children, etc)

Safe space to kōrero

Cultural practices regarding hapūtanga, birth and parenting

Is there anything else you would like us to know? (e.g., concerns, preferred days/times to connect, cultural or spiritual needs)

Thanks for submitting!