Southern Cross Gillies Hospital, Auckland - Southern Cross Healthcare

Credit Card payment

Patients of Southern Cross’ wholly-owned hospitals have the facility to make online payments, using the form provided and a valid credit card, in cases where they need to:

make a payment in advance of admission to hospital for treatment
pay an invoice received for a partial or full charge for hospital treatment
make a co-payment/excess payment for hospital treatment partly funded by insurance.

Please click on the fields to enter your details and complete the form. You should fill in all fields included unless otherwise advised. For example, you only need to enter the patient NHI (National Health Index) number if known. If not known, just leave that field blank. Once all the required fields are completed, click on ‘Proceed to next step’ (at the base of the form).

*Patient first name

*Patient last name

*Email

*Confirm email

*Phone

*Date of birth

Patient NHI number

Invoice number

*Amount to pay $

*Hospital

Fields marked with * must be completed.

Please read Privacy, Refund and Terms & Conditions

I have read and agree to the privacy, refunds and Terms & Conditions

Patient admission forms and leaflets

You will normally receive a Southern Cross patient Admission Pack from your surgeon prior to your hospital procedure. The forms contained in the pack (also available below) help our healthcare teams plan for your care. They include important questions about your personal details, health history, any special needs and payment. Please complete all sections so that we can meet your needs.

After we review your forms we may phone you to request: more information about your health, additional documents (such as power of attorney documents for personal care and welfare or Welfare Guardian document) or that you visit us for a pre-admission consultation.

Please remember to bring your 'Agreement to Treatment Form' (normally provided by your specialist) when you come to hospital.

Online Patient form for Southern Cross Gillies Hospital

Click Here for web-based Patient Admission & Patient Health Questionnaire forms. We recommend using a desktop computer or tablet for the best and easiest user experience.

Complete patient forms online

You can complete your Patient Admission and Patient Health Questionnaire forms online if you prefer. This will send your details directly to your hospital, and you will also be able to request a copy for your own reference.

To ensure privacy and safe delivery, please be sure to enter your email address correctly.

Select your hospital from the drop-down menu below to get started.

Please remember to bring your 'Agreement to Treatment Form' (normally provided by your specialist) when you come to hospital.

If you are not a New Zealand resident you will need to complete an 'Acknowledgement Form: Non NZ Resident' (PDF)

Extra resources

Read the Blood Clots & YOU brochure (PDF)

Read the Preventing infection after surgery brochure (PDF)

Watch the Staying safe before and after surgery video

Print and complete patient forms by hand

Patient Admission Form (PDF)
Patient Health Questionnaire (PDF)

Once completed, patient forms may be scanned or photographed (legibly) and emailed to your hospital, or sent by post. If posting forms, please allow 1-2 extra weeks for delivery.

Contact and postal address information can be found in your printed patient admission pack or your hospital webpage.

Please remember to bring your 'Agreement to Treatment Form' (normally provided by your specialist) when you come to hospital.

If you are not a New Zealand resident you will need to complete an 'Acknowledgement Form: Non NZ Resident' (PDF)

Blood Clots

Know your risk

This tool is intended for use by those about to undergo an elective surgical procedure.

Admission to hospital to undertake treatment puts you at HIGH risk of BLOOD CLOTS. If any of the following apply, YOU are at HIGHER RISK of developing a blood clot. Please note that there may be other factors which could increase your risk of blood clots. Please raise any issues of concern with your GP or treating medical specialist.

Select below as many of the points that apply to you.

Show my risk

Southern Cross Gillies Hospital

Patient information

Patient forms

Making a payment

Our medical practitioners

Information for young people having an operation

Contact Us

Southern Cross Auckland Surgical Centre

Complete patient forms online

Extra resources

Print and complete patient forms by hand

Southern Cross Gillies Hospital

Parking information

Patient information

Patient forms

Making a payment

Our medical practitioners

Information for young people having an operation

Contact Us

Southern Cross Auckland Surgical Centre