Registration Forms

What Type of Forms Should I Expect to Sign?

Upon arrival, you will be asked to sign Consent to Treatment form. This allows the hospital to provide the following services:

  • your care
  • bill your insurance
  • ensure you have been notified of your right to privacy
  • assignment of insurance benefits
  • financial agreement
  • provides an authorization of release of information
  • Depending on your type of insurance (Medicare or Tricare) you may also be asked to sign an additional form. Based on your treatment or procedure you may be asked to sign additional forms

Why Do You Need This Information?

Your registration information provides us with demographic, financial information and emergency contact information. Registration information is the starting point of the medical record.

What is a Medicare Secondary Questionnaire?

A questionnaire designed to assist the hospital in determining who should be the primary payer of your account in order for the bill to be sent to the correct insurance payer to avoid delays.

For additional information access the Medicare website.

Do I Need to Bring My Insurance Card With Me?

Yes, bring your most current insurance card and a photo ID with you. We have found that requesting your insurance information each time you register is the best way to ensure an accurate billing of your insurance company. 

Once this information is entered into our system, the billing is automatically sent electronically (paperless) to your insurance company. We must send accurate and updated information to avoid rejections or long delays in payment. Once your insurance company has processed your claim, a bill will be sent to you for any portion of the account balance that is your responsibility.