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