Aims The Otorhinolaryngology service in Taranaki is an under-resourced specialist service in rural New Zealand, with limited access to clinic appointments and theatre. Clinical decision making for tonsillectomy is primarily history-based, meaning there is scope for improving access to tonsillectomy by developing a proforma for direct-to-waitlist tonsillectomy referrals. The aim of this study was to determine whether there is sufficient information in referrals to the ORL service for tonsillectomy, to establish a direct-to-waitlist clinical guideline in our rural setting. Methodology We included all patients who underwent tonsillectomy from 1 February 2025 to 31 April 2025. Time from referral to clinic, and clinic to theatre was calculated. Each referral was assessed to determine whether there was adequate information to meet criteria for tonsillectomy, based on the Paradise Criteria for recurrent tonsillitis, and the Starship Hospital Guideline or Epworth Sleepiness Scale for sleep-disordered breathing or obstructive sleep apnoea (OSA) in children and adults respectively. Results The median wait times from referral to clinic appointment, and clinic appointment to date of surgery were 455 and 292 days respectively. Of the 18 patients who underwent tonsillectomy for recurrent tonsillitis, only 6 (33%) patients had adequate information in their referral to meet the Paradise Criteria for tonsillectomy. Further information was obtained to satisfy the criteria for tonsillectomy during clinic appointments. Of the 40 patients who had tonsillectomy for sleep disordered breathing, 37 (93%) had adequate referral information to meet criteria for sleep disordered breathing or OSA. Conclusions A structured proforma for tonsillectomy referrals would enable direct-to-waitlist referrals for tonsillectomy, to considerably improve time from referral to surgery. A review of surgical waitlist access is planned following the launch of this protocol in Taranaki.