Purpose There is limited evidence regarding the adherence to follow-up for colorectal cancer patients in Aotearoa New Zealand. We aim to determine the rate of adherence to national guidelines for follow-up after colorectal cancer surgery in Northland and explore factors associated with low adherence. Methods A retrospective review was conducted, evaluating all patients who have undergone curative-intent surgery for colorectal cancer between January 2013 and December 2022 in the Northland region. Adherence was defined as per the 2011 national guidelines for colorectal cancer follow-up and was measured for four components: clinic review, carcinoembryonic antigen, computed tomography and colonoscopy. Statistical analysis was performed using a binary logistic regression to assess significance of independent patient factors, with adherence separated into low or high groups by the median. Results A total of 779 patients were included. Patients, on average, attended 75% of the overall guideline stipulated follow-up. The percentage of patients that completely adhered to follow up varied by modality and was 90% for CT, 74% for colonoscopy, 29% for clinic and 26% for CEA. Only 69 (10%) patients completely adhered to all follow-up guidelines. Factors associated with low adherence were residing in a low socio-economic area (p = 0.01) and lower stage disease, with stages III (p = 0.009) and IV (p = 0.002) associated with higher adherence. Age, gender, ethnicity, rurality, comorbidity and disease location were not associated with adherence. Conclusion Adherence to follow up varied by modality. Follow-up strategies need to be explored to improve adherence, specifically for CEA and clinics, with a focus on lower socioeconomic groups.