Online admission form

  • In order to ensure your admission is streamlined, we request that you complete this hospital admission form at least 2 weeks prior to your admission date.


    Please ensure you are able to complete this form uninterrupted. You will need approximately 20 minutes to fill in this form. Fields that are mandatory are marked with an asterisk (*).


    Once you have completed this form, ensure you read and understand the pre-admission information in our patient admission section.


    This form cannot be completed without an admission date and procedure name. Please contact your Specialist if you do not have these details.

  • Important! To assist you with this process, please have the following information at hand.

    • Your personal details and support person details
    • Emergency contact details (Medical Power of Attorney, Next of Kin)
    • Medicare card
    • Funding details
    • Specialist details, including admission date and procedure name
    • List of medication(s) and dosage


    When you have completed filling in your admission form, you will be prompted to ensure that your details are correct before continuing.

  • Which hospital are you being admitted to?

    Please select a value


    To proceed, click the "Start" button below, or "Cancel" to exit this process.

* Please make sure that all mandatory fields are filled correctly

You are about to submit your form. Please make sure that all the fields are filled correctly.


Back Submit

You are about to cancel your online admission. This will delete all the information you have entered. Are you sure you want to cancel?


No Yes

Thank you for completing your online admission form at . As requested, we have emailed forms to your nominated email address and a copy of a patient information booklet we advise you read before coming to hospital. A member of staff may contact you to discuss the details of your admission. If you have any enquiries, please contact us at or email us at . Thank you for choosing Epworth HealthCare.

Thank you for completing your online admission form at . Please read the patient information booklet on our website before coming to hospital. A member of staff may contact you to discuss the details of your admission. If you have any enquiries, please contact us at or email us at . Thank you for choosing Epworth HealthCare.

An unexpected error occurred. Please contact Patient Admissions at
.

Thank you for completing your online admission form. Your admission has been submitted. However the confirmation email failed to send due to an unexpected error. Please contact Patient Admissions at
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