Obstetrical Preferred Accommodation Form

You may use this form to submit your preferred accommodations during your stay at Sunnybrook's Birthing Unit. For more information on this service please read the frequently asked questions.

Request form

Please fill in the fields below to submit your preferred accommodation.

Patient's information

First name

Middle initial

Last name

Name of your health-care provider (physician, midwife)

Medical Record Number (MRN)

Expected delivery date

Billing and contact information

Street address line 1

Street address line 2

City

Province

Postal code

Phone number

Email address

Preferred accommodation preference

Room type	Daily fee
Private	$475.00
Semi-private	$325.00
Ward	$0.00

Terms & conditions

BILLING TERMS FOR PRIVATE AND SEMI-PRIVATE ROOM ACCOMMODATION

Daily preferred accommodation fees will be charged based on the room type I am in at midnight on each day of my hospital stay. I will not be charged if I am in active labour.
If I choose a private room and one is not available due to medical need and instead I am placed in a semi-private room, I will be charged the semi-private daily fee of $325.
I can cancel my preferred accommodation room selection at any time prior to my hospital admission by emailing accommodation@sunnybrook.ca. Changes to my preferred accommodation room selection after I have been admitted will not be processed.
I am solely responsible for seeking reimbursement of any fees paid from my third party insurance.
Selection of private and semi-private room accommodation is optional. Ward rooms (room with 3 or more beds) are provided free of charge to all patients.
Your final hospital bill and official receipt for income tax purposes will be sent to the email address provided. Please email accommodation@sunnybrook.ca if you would like to arrange to receive this information by mail instead.

I have read and agree with the billing terms as noted above.

PERMISSION TO CHARGE CREDIT CARD

I give Sunnybrook Health Sciences Centre (Sunnybrook) permission to charge the credit card number provided immediately for $0.10 to authenticate the credit card. Additionally, I give permission for Sunnybrook to charge the same credit card for all charges billed in accordance with the above noted terms and rates. I understand the credit card will be charged within 7 business days of my discharge from the hospital.

I agree.

* Indicates a required field.