Thank you for your interest in pre-registering for admittance at Memorial Hospital. Pre-registering will streamline the check-in process on the day of your procedure; however, pre-registered patients must still report to the hospital admission desk upon arrival.
Please use the following pre-registration form only for hospital pre-registration. (This site does not pre-register patients for appointments at Memorial Health Clinic.)
Please complete and submit this form as soon as you schedule your procedure at Memorial Hospital - at least three business days in advance of the appointment.
Items you will need in order to complete the online pre-registration form include the following:
- Insurance Card ID Number (Group ID if applicable)
- Date of procedure or appointment
- Name of Physician with whom the appointment is scheduled
If you have questions, or would like to pre-register by telephone, call 402-694-8206 between 8:00 AM and 4:00 PM Monday through Friday. Please note, if information submitted is incomplete or requires further clarification, hospital admissions staff may need to follow up via phone.
Prior to completing your pre-registration form, you will be asked to read and accept a pre-registration disclaimer indicating your understanding and acceptance of MCHI’s practices regarding the electronic transmittal of patient information.