Virtual Visiting

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Patient's full name(Required)

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Patient's address

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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

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Your details

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Your name(Required)

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Your relationship to patient

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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

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Virtual Visiting

Virtual Visiting

Your details

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