Visitor Exemption Request Form

Currently there are entry restrictions for visitors. Please complete this form to apply for an exemption.

In accordance with Queensland Health Hospital Entry Direction (No. 7), all visitors must be fully vaccinated against COVID-19. Exemptions for unvaccinated persons entering hospitals can only be granted for the following purposes:

End of life visit
To be a support person during birth
In an emergency
A parent, carer, guardian or other responsible adult who is accompanying a child or person with a disability that is a patient of the hospital

Applications must be submitted at least two business days prior to entry. We will respond to your request as soon as possible.

Please note: This form is for inpatient visits only. If you are attending a specialist appointment, please contact your doctor for visitor requirements at their private rooms.

Visitor information

Visitor first name

Visitor last name

Visitor email address

Visitor phone number

Visitor residential address

Relationship to patient

Are you fully vaccinated against COVID-19? Yes No

Reason for exemption End of life visit To be a support person during birth In an emergency A parent, carer or guardian of a child who is a patient of the hospital A carer or other responsible adult accompanying a person with a disability who is a patient of the hospital Other (please provide details)

Proposed visit date

Proposed visit duration

Patient information

Patient first name

Patient last name

Patient date of birth

Name of Doctor caring for patient

Area of visitation

Please note

Unvaccinated parents, carers, guardian or other responsible adult, birth support people and those visiting in an emergency situation will need to comply with risk mitigation measures put in place by the hospital.
This includes testing requirements, use of single use masks, physical distancing measures.
Only one unvaccinated parent, carer, guardian or other responsible adult will be permitted at a time.

Visitor Exemption Request Form

Doctors

Services and Pages

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Visitor information

Patient information

Please note

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Visitor Exemption Request Form

Visitor information

Patient information

Please note

Lifelong

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Patients and Visitors

Key Services

THE WESLEY HOSPITAL

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