HealthSecure organisation registration form
Use this form to register your organisation for a digital certificate.
Sole practitioners, counsellors etc, must complete this application form to have your business registered with the New Zealand Health & Disability Sector Registration Authority (NZHSRA) for digital certificates.
ACC is acting on behalf of NZHSRA to process digital certificate applications for ACC and the Ministry of Health.
Prior approval required
Access to the Health Network must be approved by the Ministry of Health before we are able to proceed with this application. The Ministry of Health website provides further information and the necessary form to assist you.
What you need to fill out this form
- Your organisation’s contact details, including a named, main contact person.
- Two named authorised signatories for your organisation (if applicable).
- The vendor ID for the organisation (if applicable).
When you have all the relevant information, please allow around five minutes to enter it, as the form can’t be saved.
If you need help to complete this form, please call NZHSRA.
Phone 0800 117 590.
Complete the form below: