Patient Admission

NOTE:  this form is not currently compatible with mobile phones.  Please complete using a computer.  Alternatively collect a paper form from Grace Hospital main reception - open Monday - Friday 7am to 8.30pm.

Before starting this Patient Admission Form, you will need to have the following information at hand:
  • List of medications and/or supplements you are currently taking (including dose/frequency)
  • Previous hospital admission history (from any hospital) in last 10 years
  • Height and weight (if known)
  • Insurance member and pre-approval claim number (if known)
Please ensure to use your legal name and check your date of birth before submitting.
Please enter "unknown" for any mandatory fields you may not yet have answers to.