Completing Your Admission Questionnaire

Please complete all portions of the yellow questionnaire numbered 1-9 and return it at least one week prior to your admission date. Please use black pen to complete the form. Contact the hospital if you have any problems completing the form. You may be contacted by a Registered Nurse prior to your admission requesting further information/clarification of your health history. We recommend that you read your information booklet to assist you in completing your questionnaire.

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