Bowel Screening Promotion May 2026

Section 1 - Registration

Please complete this brief section to register for campaign resources

Question Title

* What is the full name of the practice?

Question Title

* Which Health District is the practice located in?

Auckland

Bay of Plenty

Canterbury

Capital and Coast

Counties Manukau

Hawke's Bay

Hutt

Lakes

MidCentral

Nelson Marlborough

Northland

South Canterbury

Southern

Tairāwhiti

Taranaki

Waikato

Wairarapa

Waitematā

West Coast

Whanganui

Question Title

* Is the practice a VLCA (Very Low Cost Access) practice?

Yes

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* Please enter the details of the practice contact person for the Bowel Screening Promotion

Name

Email address

Question Title

* What is the name of the practice bowel screening Champion?

Question Title

* What is the email address of the practice bowel screening Champion?

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* What is the practice type (indicate as many as apply)?

Group/Team

Solo

Iwi/Māori practice

Other (please specify)

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* Please provide the approximate number of enrolled patients aged 58-74 if known

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* Please enter the practice delivery address (we will send you promotional resources)

Name

Company

Address

Address 2

City/Town

ZIP/Postal Code

Phone Number

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* Resources are in English, with some posters also available in Te Reo Māori, Samoan and Tongan. Please select if you would like posters in these languages

Te Reo Māori

Samoan

Tongan

Question Title

* Would you like to go in the draw for a practice morning tea?

Yes