If you are having a test or procedure scheduled at XXX Hospital Name XXX, please fill out the following form in its entirety.
If you are pre-registering for an upcoming maternity visit, please remember to contact your insurance company prior to your expected delivery date to inquire about the notification process you need to follow regarding the addition of your child to your existing benefit plan.
Please Note: Online pre-registrations are checked Monday - Friday, 8:00 a.m. - 4:30 p.m. Please allow at least one full business day before your appointment for your pre-registration form to be processed. If there is less than one full business day before your appointment, please pre-register by calling the Admitting Office at XXX Hospital Phone XXX.