Registering on-line is an easy way to register any time - day or night. Gathering
information before your arrival date will help to minimize delays in your registration.
Be assured that all information is confidential. Although you are submitting insurance
information, you will still need to bring your insurance cards with you to the hospital
when receiving services. If you have any questions while filling out this form,
feel free to call. You can also preregister over the phone. Please Note: Please
allow three (3) days before your appointment for your pre-registration form to be
processed. If there is less than three days before your appointment, please call
express registration at (740) 374-1751. You must fill in all required fields for
the form to be accepted. If the field does not apply, enter "NA" or if you are unsure
what to put in, enter "??".