Please fill out this form so that we can deliver a Hospital Care Pack to you during your admission. You are welcome to choose up to 8 items, however if there is a category you don't want anything from, you may choose up to 2 items from another category.

We will do our best to fulfill your requests, however if we have run out of an item, we will replace with a similiar option.

We usually deliver bags one day per week. For any questions please contact the office at 08 6224 4100.

So that we can deliver the bag to you, please tell us the following information:

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* 1. What is your name?

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* 2. What ward and room are you in?

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* 3. Instant Noodles & Soups

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* 4. Tuna

High protein: >5g per serve
Low carbohydrate: <15g per serve

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* 5. Dried Fruit, Nuts & Trail Mixes

High protein: >5g per serve
Low carbohydrate: <15g per serve

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* 6. Chips & Popcorn

High protein: >5g per serve
Low carbohydrate: <15g per serve

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* 7. Beans

High protein: >5g per serve
Low carbohydrate: <15g per serve

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* 8. Sweet Snacks

High protein: >5g per serve
Low carbohydrate: <15g per serve

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* 9. Drinks

High protein: >5g per serve
Low carbohydrate: <15g per serve

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* 10. Would you also like any of the following toiletries? Please select up to 2 items

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* 11. Please leave a comment if you have any other suggestions

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