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Pre-Register

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.

You can pre-register online by clicking here or download our form by clicking here.

Contact Us

Admissions Office
402-694-8206

Testimonials

Patient

Thanks for the wonderful care. It was great to know I was always in good hands.