Health Passport Form

This Easy Read document is for you to fill out and keep with you when you go to the doctor, hospital, or any health service.


It helps health workers understand your needs. The passport has things like:

  • information about you like your name, contact information, and doctor.
  • Information about your needs
  • information about things that help you feel comfortable.
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Download this Easy Read document as

This Easy Read document was written by:
Health and Disability Commissioner

What is Easy Read?

Easy Read uses easy to understand words and pictures to make information accessible for people with learning disability. The Make it Easy team at People First New Zealand works with a range of organisations to translate information into Easy Read. You can find out more about Easy Read on the Make it Easy website.


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