Pre-register

You can pre-register in advance for an appointment at a physician clinic or for a hospital visit/procedure by using the secure form below. Pre-registration for all visit-procedures can be completed up to 24 hours before a scheduled appointment.

If a hospital procedure is scheduled for less than 24 hours away, please pre-register with one of our pre-registration associates by calling toll-free 1-888-844-0080 and selecting option 3. Our pre-registration department is open Monday - Friday (8 AM - 6 PM).

If a physician clinic visit is scheduled for less than 24 hours away, please pre-register with one of our pre-registration associates by calling toll-free 1-866-273-2067. Our pre-registration department is open Monday - Friday (7 AM - 4 PM).

Please note: if you are located in the Virginia area, you will need to preregister on our Novant Health UVA Health System website.

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Emergency Contact Information

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Insurance Information

Part 1: General
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PART II: Liability
PART III: Eligibility
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PART IV: Age

PART IV: Disability

PART IV: ESRD
PART V: ESRD

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Additional Insurance

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General procedure information

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Labor & Delivery Information

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