Pre-Registration - Hospital Patients
Do you have an appointment at one of our hospitals? Then we invite you to use our online Hospital Pre-Registration form to help reduce your waiting time. If your appointment is today or tomorrow, we ask that you bring the completed form with you. Otherwise, please complete the pre-registration form and fax or mail to:
Outpatient Insurance Services DepartmentSanta Barbara Professional Building 224 Santa Barbara Blvd Cape Coral, Fl. 33991 Fax: 239-343-4001 Phone: 239-424-1300
If you are covered by insurance, please send copies of the front and back of your insurance cards, if available. Our Outpatient Insurance Services staff will begin pre-registration once we receive the completed forms. Thank you!
Pre-Registration - Maternity
We also offer pre-registration for our maternity patients before your expected delivery date.
Please download and save the Maternity Pre-Registration form (English) (Spanish) to your device. To download, right click on the form icon or link text, select “Save target as” or “Save link as” and save the file.
To send electronically (preferred):
- Open and complete the form on your device. Save the document once completed.
- Submit the completed document by attaching it to an email and sending to [email protected]
- Attach copies of insurance cards and photo ID to the email.
Alternatively, you may print the completed form and mail it to the address located at the top of the form. Please send copies of the front and back of insurance cards, if available. Many insurance plans require pre-authorization for your admission for your baby’s delivery.
Check with your employer’s benefits office or insurance company representative to make sure you meet notification requirements.
If you are unable to complete the pre-registration forms in advance, you and your support person will need to allow extra time to complete the registration process when you arrive at the hospital.
Please bring your photo ID and insurance cards.