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Form Filling - Practice 1

Southbank Hospital Registration

Questions 1-6

Complete the form below.
Write NO MORE THAN TWO WORDS AND/OR A NUMBER for each answer.


Surname: 1

First name: 2

Home address: 3 Drive

Postcode: 4

Nationality: 5

Arrival date: May 12th

Departure date: 6

ANSWERS

Answers

1. Roberts

2. Michelle

3. 85 North Hillcrest

4. 32K 156

5. Dutch

6. May 18th

Transcript

Mr. Bill: Now, before we can admit you into the birthing ward, we have to first get you to fill out this registration form.
Michelle: But my baby’s coming and the contraction’s getting worse.
Mr. Bill: The baby’s not coming this instant, dearie, and this takes just a moment. So your name is Mrs. Roberts (Q1) – R-O-B-E-R-T-S, right?
Michelle: Yes, Michelle Roberts on 85 North Hillcrest (Q2&3) Drive.
Mr. Bill: H-I-L-L-C-R-E-S-T. Correct?
Michelle: Yes.
Mr. Bill: And what is your postcode?
Michelle: Well, I just moved there. I think it’s 32K 156 (Q4).
Mr. Bill: Now you seem to have an accent. Where are you from?
Michelle: I’m from the Netherlands. So I’m Dutch (Q5).
Mr. Bill: Thanks. Now for arrival time. Today is the 12th. You should be here for six nights and seven days, so you should be checking out on the 13th (Q6). There, that’s everything. You can go to your birthing room now.
Michelle: Thanks.