Important information about your patient admission forms
- We need to receive your patient admission forms at least two weeks before your admission, although receipt as early as possible is appreciated.
- Please use a desktop computer or tablet to complete your admission forms.
- By clicking Submit at the end of this form, all entered data will be sent to Southern Cross Christchurch Hospital. A copy of this form will also be sent to the email address entered in the Personal and administrative details section.
- Any field marked with a * is a mandatory field. The form can not be submitted until all mandatory fields are completed.
- Free text fields in the form have character limits. If the text colour changes to red it means the limit is exceeded. Use the backspace key to reduce the text, until the background returns to white.
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Please NOTE:
- Free text fields in the form have character limits and if the colour changes to light red it means the limit is exceeded and should be reduced, until it is white.
- Any field marked * is a mandatory field and the form will not submit until all these fields are filled.