Patient Intake Form
Disclaimer
Submitting a request for admission to EACH does not guarantee admission. All requests are subject to review based on patient needs, service capacity, and medical criteria.
Our website does not require or request the uploading of any confidential or personal documents. Only basic contact and inquiry details are needed to initiate the process.
Once your request has been received, you can expect a response of the outcome within 48 hours via telephone or email, The following documents are required for all patient admissions, please ensure that you have these ready when we contact you:
• Patient ID
• Referral Letter
• Completed Preliminary Intake Form
• Proof of Funeral Cover
• Current Medical Scripts
If you do not receive a response within the given time frame, please escalate your query to:
Office hours contact details:
Emergency contact details:
Joyce Leander 012 806 8215 / 084 544 8755 (weekdays),
Hospice 012 806 6338 (weekends)
EACH Office Manager - Ms. J. Leander
📧 Email: info@eachhospice.org.za 📞 Phone: +27 (0)12 806 8215/6338By filling in and submitting the message request form, you:
• Consent to EACH contacting you via the provided contact details.
• Acknowledge that the request form is not an admission guarantee.
• Agree to the processing of your personal information in line with POPIA (Protection of Personal Information Act).
Partners & Donors of EACH