Information for Health Professionals

Referral forms

General Referral Form
Dental Referral Form

Other services

Information about our other current services and how to access them is contained within this section of the website. Please visit this page regularly as the level of service offered fluctuates to reflect volunteer specialist availability. The following list was updated in May 2022.

Our current services (subject to change) are:

General surgery

Most hernia types, pilonidal disease, haemorrhoids, anal fissure etc.

Rectal Bleeding Clinic

Criteria for PR bleeding clinic

  • Aged <50 years
  • History of rectal bleeding for at least 4 weeks
  • No other colorectal signs or symptoms
  • No health insurance

This clinic has been developed as a joint initiative between the Canterbury Charity Hospital and Canterbury DHB to meet unmet need.

Please request PR bleeding clinic on your referral request. Patients will be seen weekly at the Charity Hospital.

This service is for patients who do not have any other colorectal signs or symptoms ie have low risk of colorectal cancer.

These particular patients do not have to be declined publicly funded treatment to be referred to this clinic.

Patients will have appropriate investigations and treatment (eg flexible sigmoidoscopy and treatment of their condition eg banding or injecting of haemorrhoids and biopsy of polyps). Subsequent colonoscopy may be required as a result of investigations and these will be done primarily at the Canterbury Charity Hospital or the CDHB for those deemed more urgent.

Endoscopy (Colonoscopy)

Symptomatic and screening

1. Symptomatic Patients
Unexplained overt rectal bleeding for six weeks or more. Visit  HealthPathways for more information about the criteria.
Note: Occult blood and faecal culture for microbes and parasites and calcoprectin results are required with the referral.

2. Referrals for CRC Screening
Category Two Patients as follows: One first-degree relative with CRC diagnosed before age 55 years, or two first-degree relatives with CRC diagnosed at any age. Recommendation is colonoscopy every five years from age 50 years (or from an age 10 years before earliest age at which CRC was diagnosed in the family, whichever is earlier).

3. Referrals for Post-CRC Surveillance
Currently surveillance for patients with a personal history of CRC is ceased once the patient is aged 75 years – we will see such patients as long as they strictly meet our criteria for day surgery management, and are able to safely take the bowel preparation at home (ASA2 only).

Note: The Canterbury Charity Hospital is unable to offer a diagnostic service for the investigation of abdominal pain and diarrhoea.

Gynaecology, women's health and family planning

We offer tubal ligation, Mirena, gynaecology procedures and diagnostic laparoscopy for endometriosis.


We provide vasectomy, adult circumcision (secular only), penile correction of Pyronie’s disease and non-lobulated hydrocele.

Dental and Oral Surgery service

Free dental and oral surgery services are provided by volunteers (predominantly by members of the Canterbury branch of the New Zealand Dental Association). Services are offered to patients from 18 to 65 years of age. A one off/non-emergency course of treatment can be provided for WINZ* and City Mission clients.  All dental patients MUST be referred by a dentist.

The following dental and oral surgery services are provided:

  • Examinations and radiographs
  • Extractions
  • Direct restorations: Behind the canines, provision of single or multi-surface restorations using amalgam and glass ionomer only. And the front six teeth (3 to 3), single or multi-surface restorations.
  • Scale/prophylaxis
  • Preventative care/advice
  • Endodontics 13, 12, 11, 21, 22, 23, 41, 42, 43, 31, 32, 33 only
  • Wisdom teeth extraction, total clearances and complex extractions under sedation. The Canterbury Charity Hospital is unable to provide crowns or implants. General dentistry is offered with local anaesthesia.
  • Dental hygienist treatment

* We can see people who are receiving the WINZ supportive living payment, jobseeker support, sole parent support and child disability allowance.

Orthopaedic surgery - hand, upper limb and foot surgery

Carpal tunnel decompression, Dupytrens contracture, Trigger finger, Bursa, Arthrodesis distal joints, Hammer Toe correction, Tenotomy Toe, Removal bone spur, Excision neuroma, Tarsal tunnel release, Toe amputation, Tailors bunion excision and Bunion surgery (minor to moderate day surgery compatible).

Eye surgery

Cataract surgery with a national prioritisation score and decline from the CDHB


Counselling services

 Counselling is available for most age groups with conditions related to anxiety/depression, grief, ADHD, family therapy, group support, child behavioural issues, anger management.

We don’t see cases related to drugs and alcohol (in isolation), psychosis, chronic personality disorder, people who commit crime with mental health issues, patents with known suicidal intent.


Dermatological solutions are available at the Canterbury Charity Hospital for  patients 16 to 26 years with acne scarring.  The clinic is for those patients who have completed acne treatment and the acne is no longer active.

This clinic is not an acne treatment clinic although an exception may be made in rare instances such as Acne Fulminans where the General Practitioner is unable to get the patient’s acne under control.

Please see guidance notes and the assessment form which must be included with your referral along with  two colour photographs.

Guidance notes and assessment form


Dietetic advice

General and specialised advice related to most health conditions including pre and post surgery advice and weight loss management.

Patient criteria

Any patient you refer must meet our criteria and the patient referral declaration form is your guide to determining eligibility. The patient must meet both clinical and financial requirements of the Trust.  If your patient fits our criteria then we would be pleased to offer them FREE treatment at our hospital.

Documents required for referral are:

  • Referral and declaration form (available below). Essential.
  • A written detailed referral letter including full medical history including BMI/weight, height or an ERMS
  • Decline letter from DHB
  • A completed Christchurch Hospital ophthalmology referral score sheet with a National Prioritisation Score attached (for Cataract referrals)

Our services operate on the basis of goodwill and the flexibility of volunteer staff. It is expected that referrers work with the trust to provide the best outcomes for our patients. Canterbury Charity Hospital is a day care charitable facility; we do not have overnight care facilities on site.

The services we provide fluctuate from time to time dependent on the numbers of volunteer staff available at that time. We are closed over the Christmas holiday period, weekends and public holidays.

Referral Forms

General Referral Form
Dental Referral Form

Open evenings for GPs and other Health Professionals

If your group would like to attend one of these evenings, please email us at

Anaesthetic Guidelines

Patient selection is important. Volunteer anaesthetists have agreed that we will offer surgical treatment to patients in ASA Classes 1&2 only.

ASA stands for American Society of Anaesthesiologists. New Zealand Anaesthetists have adopted the ASA system for classifying the pre-operative physical status of patients. Below is the classification, with definitions (often abbreviated as ASA1, ASA2, etc):

Class 1 Healthy patient, no medical problems
Class 2 Mild systemic disease
Class 3 Severe systemic disease, but not incapacitating
Class 4 Severe systemic disease that is a constant threat to life
Class 5 Moribund, not expected to live 24 hours irrespective of operation