Tokai Healthcare Visitor Booking Form(Sub-Acute Residents)
Visitors to the Faircape Health Tokai Centre will be required to wear a face mask when in communal or public indoor areas of the facility only
Date
*
 -
Day
 -
Month
Year
Date
Visitor Name & Surname
*
First Name
Last Name
Visitor Email
*
example@example.com
Visitor Contact details
*
 -
Area Code
Phone Number
Visitor Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Visitor Id Number
Have you been Vaccinated(Please note we only accept vaccinated visitors for visitations inside our healthcare, and we will be asking for proof of vaccination on visitation, Should you not be vaccinated, you are only allowed outside Visitation)Â *
Yes
No
Relation to Resident/Patient
*
Resident/Patient Name
*
First Name
Last Name
Bed Number
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Visitation Type (Please note the bookings for the outside area is weather dependent and we cannot accommodate these visits if the weather does not allow for it, neither are we able to make alternative arrangements)
*
Outside Area
Inside Controlled Visits
Appointment - Outside
*
Appointment - Inside Controlled Visits - Bed 1
*
Appointment - Inside Controlled Visits - Bed 2
*
Appointment - Inside Controlled Visits - Bed 3
*
Appointment - Inside Controlled Visits - Bed 4
*
Appointment - Inside Controlled Visits - Bed 5
*
Appointment - Inside Controlled Visits - Bed 6
*
Appointment - Inside Controlled Visits - Bed 7
*
Appointment - Inside Controlled Visits - Bed 8
*
Appointment - Inside Controlled Visits - Bed 9
*
Appointment - Inside Controlled Visits - Bed 10
*
Appointment - Inside Controlled Visits - Bed 11
*
Appointment - Inside Controlled Visits - Bed 12
*
Appointment - Inside Controlled Visits - Bed 13
*
Appointment - Inside Controlled Visits - Bed 14
*
Appointment - Inside Controlled Visits - Bed 15
*
Appointment - Inside Controlled Visits - Bed 16
*
Appointment - Inside Controlled Visits - Bed 17
*
Appointment - Inside Controlled Visits - Bed 18
*
Appointment - Inside Controlled Visits - Bed 19
*
Appointment - Inside Controlled Visits - Bed 20
*
Appointment - Inside Controlled Visits - Bed 21
*
Appointment - Inside Controlled Visits - Bed 22
*
Appointment - Inside Controlled Visits - Bed 23
*
Appointment - Inside Controlled Visits - Bed 24
*
Appointment - Inside Controlled Visits - Bed 25
*
Appointment - Inside Controlled Visits - Bed 26
*
Appointment - Inside Controlled Visits - Bed 27
*
Appointment - Inside Controlled Visits - Bed 28
*
Appointment - Inside Controlled Visits - Bed 29
*
Appointment - Inside Controlled Visits - Bed 30
*
Appointment - Inside Controlled Visits - Bed 31
*
Appointment - Inside Controlled Visits - Bed 32
*
Appointment - Inside Controlled Visits - Bed 33
*
Appointment - Inside Controlled Visits - Bed 34
*
Appointment - Inside Controlled Visits - Bed 35
*
Appointment - Inside Controlled Visits - Bed 36
*
Appointment - Inside Controlled Visits - Bed 37
*
Appointment - Inside Controlled Visits - Bed 38
*
Appointment - Inside Controlled Visits - Bed 39
*
Appointment - Inside Controlled Visits - Bed 40
*
Appointment - Inside Controlled Visits - Bed 41
*
Appointment - Inside Controlled Visits - Bed 42
*
Appointment - Inside Controlled Visits - Bed 43
*
Appointment - Inside Controlled Visits - Bed 44
*
Appointment - Inside Controlled Visits - Bed 45
*
Appointment - Inside Controlled Visits - Bed 46
*
Appointment - Inside Controlled Visits - Bed 47
*
Appointment - Inside Controlled Visits - Bed 48
*
Appointment - Inside Controlled Visits - Bed 49
*
Appointment - Inside Controlled Visits - Bed 50
*
Appointment - Inside Controlled Visits - Bed 51
*
Appointment - Inside Controlled Visits - Bed 52
*
Appointment - Inside Controlled Visits - Bed 53
*
Appointment - Inside Controlled Visits - Bed 54
*
Appointment - Inside Controlled Visits - Bed 55
*
Appointment - Inside Controlled Visits - Bed 56
*
Appointment - Inside Controlled Visits - Bed 57
*
Appointment - Inside Controlled Visits - Bed 58
*
Appointment - Inside Controlled Visits - Bed 59
*
Appointment - Inside Controlled Visits - Bed 60
*
Appointment - Inside Controlled Visits - Bed 61
*
Appointment - Inside Controlled Visits - Bed 62
*
Appointment - Inside Controlled Visits - Bed 63
*
Appointment - Inside Controlled Visits - Bed 64
*
Appointment - Inside Controlled Visits - Bed 65
*
Appointment - Inside Controlled Visits - Bed 66
*
Appointment - Inside Controlled Visits - Bed 67
*
Appointment - Inside Controlled Visits - Bed 68
*
Appointment - Inside Controlled Visits - Bed 69
*
Appointment - Inside Controlled Visits - Bed 70
*
Submit
Should be Empty: