The MS 336 pre-admission questionnaire is one page long. Fill it out using the PDF editor on this page, then download or print the completed file to submit to Mount Sinai Hospital in Toronto.
How to Complete the Maternity Pre-Admission Form
- Full name and date of birth - Print your name exactly as it appears on your health card. Add your date of birth in the format shown on the form.
- Health card number - Enter your provincial health card number and version code. Ontario residents use their OHIP card. Patients from other provinces use their home province card.
- Mount Sinai White Card number - If you have visited Mount Sinai Hospital before, enter your White Card number here. New patients can leave this field blank.
- Home address and contact details - Include your current address and a phone number where the hospital can reach you before your admission date.
- Expected delivery date - Write your estimated due date. Your obstetrician or midwife will confirm this date.
- Pregnancy risk level - Check the box for high-risk or low-risk pregnancy as classified by your care provider. Also indicate if you are expecting twins or other multiples.
- Room preference - Select ward, semi-private, or private room. Review your insurance plan before choosing a paid room type, as availability is not guaranteed.
- Emergency contact and next of kin - Write the name and phone number of the person the hospital should contact in an emergency.
- Interpreter requirement - Check this box if you need language assistance during your stay. Mount Sinai will assign an interpreter for your admission.
What to Bring on Admission Day
Mount Sinai Hospital asks patients to bring three items on the day of admission: your provincial health card, proof of supplementary health insurance, and a credit card for incidental charges. Non-Canadian residents must confirm payment arrangements with the billing office well before the delivery date.
Leave jewelry and other valuables at home. The hospital cannot be responsible for personal belongings during your stay.
Frequently Asked Questions
Who must complete this pre-admission questionnaire?
All patients scheduled for maternity admission at Mount Sinai Hospital in Toronto must fill out this form. Your obstetrician or midwife will advise when to submit it, typically several weeks before your due date.
Can I complete the form online?
Yes. Use the PDF editor on this page to type directly into each field. When you are done, download the completed PDF and submit it to the hospital admissions office as instructed by your care team.
What is the Mount Sinai White Card?
The White Card is a patient identification card issued by Mount Sinai Hospital. It carries your medical record number. First-time patients do not have one yet and should leave that field blank.
Do I need other forms for my maternity admission?
Depending on your situation, you may also need a prenatal care form to share health history with your team. A birth plan form can record your delivery preferences for hospital staff. If you are applying for Employment Insurance maternity benefits, a Service Canada Medical Report may also be needed. For a general hospital admission template, see our hospital admission form.
When should I submit the pre-admission questionnaire?
The hospital recommends submitting the form well before your due date. Contact Mount Sinai Hospital directly to confirm the required submission window, as it may vary by care team and delivery plan.