Online admission form

Completing the Online Admission form

As soon as you have an admission date to Epworth, please submit the Online admission form.

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.

FAQs

Please refer to our FAQs if you're experiencing issues completing the form.