Southern Cross Hospitals

Patient Forms & Leaflets

Patients will normally be given a Southern Cross Hospitals Patient Admission Pack by their surgeon or their surgeon's rooms. This pack includes three forms that must be completed prior to admission to a Southern Cross Hospital.  If you have misplaced your original forms, they can be downloaded and printed from this page (see below).
These forms assist the health team to plan your care. They include important questions about your personal and contact details, health history, consent for treatments, any special needs and payment arrangements.
Please complete all sections fully so that we are able to meet your particular needs and deliver on our promise of quality care.
Please ensure that all completed forms reach the hospital, if possible, no later than five business days prior to your admission. They can be posted, faxed, scanned and emailed or hand delivered to the hospital. If you fax or scan your forms, could you please bring the originals with you to the hospital when you are admitted.
If you are not a New Zealand resident you are required to complete an ‘Acknowledgement Form: Non NZ Resident’
Your Patient Admission Pack also contains the following leaflets:



Any personal or health information we collect from you or your health services provider is collected for the purposes of providing your treatment at a Southern Cross hospital, for quality assurance activities and to fulfil legislative requirements.
Your rights provided in the Health Information Privacy Code and the Privacy Act 1993 will be respected including your right to access and, if necessary, request correction of any information we hold about you. If you have any concerns, please contact the hospital to speak to the Hospital Manager who is the Privacy Officer.
More information on the Health Information Privacy Code and the Privacy Act 1993, and the Health and Disability Code of Rights can be found in the patient information compendium located in your hospital room or the day-stay area 


Patient Forms FAQs

I have not received a Patient Admission Pack from my surgeon?


Please contact your surgeon’s rooms and request one.

When should I complete the forms in the Patient Admission Pack?


Please allow enough time for all completed forms to reach the hospital no later than five business days before your admission.

Once the decision has been made for you to have surgery or a procedure at Southern Cross Hospital, you will be given a Patient Admission Pack. This pack includes admission information and three hospital “Forms to fill out” that require completion prior to your first visit. Please also list your current medications, any special dietary requirements, any food preferences, and any special needs you may have on your admission form and we will endeavour to meet your requirements. Ideally we would like to recieve your completed forms five days before your admission. Click here for other information on what to organise before your admission.