Virtual Visiting

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Patient's full name(Required)

Please enter patient's full name here

Patient's address

Please enter patient's address here

Patient's date of birth

If you are aware of the patient's date of birth, please enter here.

Please let us know which of our site/s, centres, the patient is at.

Northern Hospital Epping

Broadmeadows Hospital

Bundoora Centre

Palliative Care Unit

Ward

Please let us know which ward the patient is in

Your details

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Your name(Required)

Please enter your name here.

Your relationship to patient

Please indicate your relationship to the patient

Your email address(Required)

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Your phone number

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What type of visit would you like?

Audio call

Video call

Please let us know if you prefer an audio call or a video call

Preferred date (s) or time (s) for your virtual visit?

Will additional assistance be needed to set up the Virtual Visit for the patient? For example, will your loved on require assistance holding the device steady, or learning to using the device for a call?

Yes

Consent

Please note: We are unable to disclose patient information without their full consent. This means you may not hear from our team until the patient in hospital has confirmed and approved connecting with you. We sincerely apologize for any delays this may cause in contacting your loved one. There may be circumstances where we are unfortunately unable to facilitate this contact.

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Virtual Visiting

Virtual Visiting

Your details

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