Upon your arrival at the hospital, please stop at the Patient Registration
area to complete the registration process.
NOTE: Here are some "tips" to keep in
mind when filling out the form:
WILL BABY BE COVERED UNDER INSURANCE?
(If yes, have you notified the insurance company?)
Upon receipt of this completed pre-registration
form, a representative will verify your insurance and then
follow up with you regarding any co-insurance payment that
may be due at the time of service.
How do you prefer we contact you for the follow up?
PLEASE BRING ALL INSURANCE CARDS AND DRIVER’S LICENSE WITH YOU TO PATIENT REGISTRATION WHEN YOU ARRIVE.
If you have questions regarding insurance coverage or payment options, please contact our financial counselor at 812-842-4240.
I understand that I still need to report to the registration area upon arrival to complete my registration process.
If this is a maternity/C-section visit, have you notified your insurance company of the new arrival?