Patient Registration
We strive to make patient registration as simple and convenient as possible.
You have the ability to pre-register for your visit to one of our facilities
using one of the following options:
Pre-register online
Complete the form and transmit. If questions have not been answered, a patient access representative
will obtain information when you arrive for service.
Click here to pre-register online.
Fax your pre-registration form
Complete the online pre-registration form. Print completed form.
Fax to our Patient Access Department for all four facilities at (574) 247-5401.
Call the Patient Access Department
(574) 247-5400 or toll-free (888) 455-4450
Pre-registration hours:
Monday - Thursday 8 am - 8 pm
Friday 8 am - 5 pm
Be prepared to provide:
- Date of surgical procedure or test
- Demographic information
- Insurance information (on card)
- Complete physician name(s)
You can pre-register when a test or surgical procedure has been scheduled. Online pre-registration
may occur up to 56 days before the scheduled date. If you are unable to meet this timeframe,
re-registration can be completed by telephone, prior to your service.
Click here to read answers to Frequently Asked Questions about Patient Registration.
Click here for insurance and financial information.