Accessable - assessor identification form
Greetings
Thank you for your interest in registering for our new aSAP platform. Please note, you must be authorised to access this system:
- For northern region DHB staff and other assessors ordering for people through a DHB/MOH contract, you must be an accredited assessor, or have service accreditation verified by your DHB
- For ACC assessors, you must work for an authorised provider or a provider that contracts to an authorised provider – this information must be submitted for verification.

If you work for more than one provider, we require a unique email address to register you against each provider. Please complete as many forms as you need to register under each provider.

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Email *
First Name *
Last Name *
MOH AEA Number (DHB contracts)
Organisation (that holds the ACC or MOH contract) *
Branch/Department Name
Contact number - Landline
example : 091234567
Contact number - Mobile
example : 0123456789
Delivery Address - Company Name
Delivery Address - Building/Department
Delivery Address - Street
Delivery Address - Suburb
Delivery Address - City
Delivery Address - Post Code
Submit
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