Pre-Register for Your Visit

Why wait in line when you can pre-register online? Saint Francis Healthcare lets you pre-register for hospital admissions, as well as medical procedures, X-rays, lab tests and obstetrics. Register up to six months – and until 48 hours – before your admission.

Pre-registration disclaimer

This is for the pre-registration of non-emergent patients only. Please submit this online pre-registration at least 48 hours in advance of your hospital check-in to ensure timely process. If you choose to utilize our pre-registration form, understand that you do so at your own choice and risk. Any information you submit via the pre-registration form is confidential and is only shared with third parties as outlined in our Privacy Policy.

 If you elect to electronically submit a completed pre-registration form or any other information to  Saint Francis Healthcare through this website, you agree that you do so at your own choice and risk, and that you assume all responsibility for any liability arising from such electronic submission and from any errors or omissions in the data you provide. You agree to release and hold  Saint Francis Healthcare and its affiliates (including its directors, officers, employees, shareholders, agents and representatives) harmless from any and all liability or cause of action arising from the interception, access or use by a third party of any information submitted electronically by you through this website and from any errors or omissions in the data you provide. Additionally, the provision of any information to  Saint Francis Healthcare by you through this web site, including a completed pre-registration form, does not create or constitute any relationship between you and  Saint Francis Healthcare, its affiliates, or any of the physicians on its staff, to which any privilege may attach.

Fields marked with an asterisk (*) are required.

Current Step: 1 - Patient Information
Date format: MM/DD/YYYY
SSN format: 999-99-9999
Phone format: XXX-XXX-XXXX
Phone format: XXX-XXX-XXXX
Best Way to Contact You
Best Time to Contact You
Continue