Welcome to our secure Online Admission Form. Here you can conveniently fill in your relevant details and complete your hospital pre-admission online.
If you would like assistance in completing and submitting the form, please contact us on 03 5022 2611 or email reception@mildpriv.com.au.
By completing this form, I acknowledge that I have read and understand the information contained within the following:
Further information
The above online admission form includes Preadmission Planning (MR1), Consent forms, Patient Health Questionnaire, Health History, Discharge Planning Questionnaire and Patient Registration. It is extremely important that you complete all sections on the forms submit at least 14 days prior to your procedure. The completed Patient Health questionnaire section of the form provides information to your health care providers that is essential in delivering your care. The information required includes past and present medical history, current medications and any drug reactions or allergies that you may have. Hospital Reception hours are 6.30am to 8pm Monday to Friday and 8.30am to 4.30pm Saturday and Sunday. Reception Staff will confirm your level of cover with your health insurer and provide you with an estimate of any out of pocket expenses that you may have. You will also be provided with a Preadmission Checklist document that provides a checklist for you to follow prior to and during your hospital visit. You will receive a text message from the hospital the day prior to your procedure, notifying you of your fasting times, hospital admission time and if a Day patient your estimated time of discharge. For procedures scheduled on a Monday or a day a following a public holiday, you will receive a text message on the Friday prior.