Please fill out your online pre-registration at least two (2) full business days before your scheduled visit. Once we receive your online form, Admissions will process your pre-registration. We may contact you if we need more information.
If you are pre-registering less than two full days before your visit, please call the location of your appointment during business hours.
Maternity—Pre-Registration for delivery only
Out-Patient Testing—X-ray, mammogram, MRI, CT scan, ultrasound, lab work, etc.
Same-Day Surgery—Surgical procedures not requiring an overnight stay
Other—Hospital Admission, other services
Before You Register
To complete your registration form, you will need:
- Patient information—Name, address, phone number(s), Social Security number, date of birth
- Patient employer information (if applicable)—Employer name, address, phone number
- Alternate contact information—Name, phone number(s) of contact person (preferably, someone who does not live at your address)
- Your physician information—Name of your primary care physician or family physician
- Insurance information (if applicable)—Insurance company name, address, subscriber’s name, Social Security number, policy ID number and Group ID number (this is information shown on the subscriber’s insurance card)
- Financially responsible person information—Name, address, Social Security number, date of birth, phone number(s), employer name and employer address
- Accident details (if your visit is related to a recent accident)—Description of accident, including date of accident/injury, liability insurance company name, address and phone number