WPH Pre-Admission Forms

WPH Admission Guide

Patient Registration (MR100)/Pre-Admission Health Questionnaire (MR200)

Prior to your admission to Western Private Hospital you will need to complete and send in some forms.  These forms can be found in the above link titled ‘’Patient Registration (MR100)/Pre-Admission Health Questionnaire (MR200)”.   The forms may be competed (allow approximately 15 minutes) and submitted online to our Pre-Admission staff or printed and faxed to 9319-3184.  Alternatively, the forms may be dropped at Western Private Hospital Reception (between 6am and 6pm Monday to Friday) at 1-9 Marion Street, Footscray or posted to PO Box 4258, West Footscray, 3012 or emailed to preadmissions@westernprivate.com.au.

Clicking on the link above will download the form to your local PC. 

To complete and submit this form you will need Adobe Reader on your device, if required, please ensure you download/install Adobe Acrobat Reader DC before you start.  Complete the form in Adobe Acrobat Reader and save it to your local device to print or email.  DO NOT complete the form in browser.