CF Hospital Packs for Inpatients

CF Hospital Packs for Inpatients

Please fill out this form if you would like a Hospital Pack during your admission. Contents will vary depending on supplies available. Please indicate your preferences and we will try to deliver your bag in the next 2 business days.
Which hospital are you at?*

Perth Children's HospitalSir Charles Gairdner HospitalFiona Stanley HospitalOther
- Parent / Carer's Name*
  
  First NameLast Name
- Parent / Carer's Email*
  example@example.com
- Parent / Carer's Phone Number*
  Please enter a valid phone number.Format: 0000 000 000.
- Child's Name*
  
  First NameLast Name
- Child's Date of Birth*
  
  DayMonthYear
  Date
- Child's ward and room number*
- Your hospital discharge date (if known)
- Hospital Snack and Activity Packs
- CFWA Hospital Snack Packs
  
  Have you already received your CFWA snack pack from the CF nurses on the ward?
  
  If not, please ask your CF nurse.
- CFWA Hospital Activity Bag
- Would you like an age-appropriate Hospital Activity Bag for your child?
  
  Yes pleaseNo thanks
- Child's interests - Please select some of your child's interests to help us prepare a bag (items are subjects to availability and funding).
  
  CraftLegoArt / colouringPicture BooksGames / fidget toysOther
- CFWA Support
- Would you like to be contacted by the Services team about CFWA support? (e.g. subsidies, home support).
  
  Yes pleaseNo thanks
- Name*
  
  First NameLast Name
- Email*
  example@example.com
- Phone Number*
  Please enter a valid phone number.Format: 0000 000 000.
- Your hospital ward and room number*
- Your hospital discharge date (if known)
- CFWA Hospital Bag
- Please note, hospital packs to Fiona Stanley may take longer than 2 days to deliver. For any questions please contact the team at services@cfwa.org.au
- What kinds of food/items would you like in your bag? (select all that apply)
  
  Savoury food itemsSweet food itemsSoft drinkCoffee sachetsActivity e.g. puzzle book, colouring in, LegoToiletries
- Do you have any dietary requirements or other comments?
- Hospital Data
- Do you need data in hospital? If you’re an inpatient at SCGH, you may be eligible for a free SIM card. Each SIM includes 20+GB of data every month, unlimited calls and texts and is valid for 12 months from activation. Please note, you will need to bring your own device that accepts a SIM card e.g. phone, tablet, laptop (via dongle).
  
  Yes I'm interestedNo I'm not interested
- CFWA Support
- Would you like to be contacted by the Services team about CFWA support? (e.g. subsidies, home support).
  
  Yes pleaseNo thanks
- Should be Empty:

CF Hospital Packs for Inpatients

Hospital Snack and Activity Packs

CFWA Hospital Snack Packs

CFWA Hospital Activity Bag

CFWA Support

CFWA Hospital Bag

Hospital Data

CFWA Support