Pre-Register Clinical History
Welcome to our Online Patient Pre-registration form! Prior to the day of your procedure, please complete each field to the best of your ability. You will be asked for both demographic and health history information that will assist us in planning for your care while at our facility. Once you click “submit” at the bottom of the form, your information will be sent securely to a secure mailbox at the facility. The only people who will have access to the information you submit will be healthcare professionals who are directly involved in the coordination of your care. One of our nurses will contact you by phone to verify the information and answer any questions you have regarding your procedure.