Online Admission Form

Welcome to our secure online Admission Form. Here you can fill in your relevant details and complete your hospital pre-Admission online, conveniently and confidentially.

Please have the following information at hand when you fill in your online pre-Admission Form:

• Personal/next of kin details
• Medicare card
• Funding details (e.g. Private Health Insurance, DVA etc)
• Benefit details (e.g. pension card)

If you have any problems completing the form, please contact our patient eligibility clerk on 6432 6017 or [email protected]

Acknowledgements

By completing this form, I acknowledge that I have read and understood the information contained within the following:

• North West Private Hospital Admission Information
• Private Patient's Hospital Charter
• Your right to privacy under the Privacy Act
• Informed Financial Consent
• Payment information

I have read and understand my rights and responsibilities and how to make a compliment / complaint should I need to do so?

• Rights and responsibilities
• Patient feedback

Click below to open the Online Admission form:

Please note the online admission form is accessible from any device using the following compatible browsers; Microsoft Edge, Google Chrome, Firefox and Safari.