Please note, we are currently not able to deliver hospital support packs to you on the ward. Please fill out the form below and then contact us on 08 6224 4100 to organise collection from our office.

Please fill out this form so that we can supply 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.

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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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