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Referral form (for organisations)


Referral for insulation, heating, LED replacement lighting and some other CEA services. For self-referrals please fill in the appointment form.


We provide services for the Canterbury region, from the Rangitata River to Kaikoura, as well as the West Coast.


* indicates required field

Name and Contact Details
Patient / Client Name *
Installation address *
Suburb / RD No. *
City / Town *
Postcode find your postcode *
Phone (home) *
Phone (work)
Phone (mobile)
Ownership details *
Does the person living in the house have a Community Services Card ? *
Services required
There is someone in this household whose health would benefit from having their home's insulation and heating upgraded *
Full name of patient (if different from above)
Patient date of birth
If referrer is not a medical professional or approved referrer, the patient must consent (please tick if verbal consent has been given)
Referrer Details
Referrer name *
Referrer type *
Organisation name *
Street address *
Suburb / RD No. *
City / Town *
Postcode find your postcode *
Referrer phone *
Referrer email *
Contact / Support Person (only if required)
Name (support person)
Relationship to patient / client
Phone (day)

Community Energy Action cannot guarantee that any insulation or heating measures can be installed until after the house has been assessed. Acceptance into the project is entirely at the discretion of Community Energy Action.



Community Energy Action

0800 GET WARM (0800 438 9276)

+64 3 374 7222

299 Tuam Street, Christchurch

make an APPOINTMENT (householders)

form CURTAIN BANK (measurements)

Christchurch Content Mangement Website