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.

To complete and submit this form online you will need Adobe Reader on your device, if required, please ensure you download Adobe Acrobat Reader DC before you start.  Alternatively, complete the form and save it to your device to print or email.