top of page
Doctor Checking a Form

Online Admission Form  

Pacific Day Surgery uses an online, cloud-based program for admitting patients to our hospital for surgery.


The admission forms will take approximately 15 minutes or less to complete online. If you have completed these already, you can re-use them/ alter if needed.  

 

Please have the following information ready: 

  • Date of surgery

  • Health insurance details

  • Medicare number

  • Your full name

  • Your residential address (Not a P.O Box)

  • Contact information for yourself and your pick-up person (for patients undergoing general and neuroleptic sedation)

Screen Shot 2019-02-12 at 12.10.50 pm.pn

 Complete the online form by clicking button below

bottom of page