Patient Registration

Online Patient Registration

We are committed to making your registration experience easy and efficient. Our online pre-registration forms are easy to complete and should take about 15 minutes. Completing these forms will save you time upon arrival for your scheduled visit.

  • If this is an emergency, call 911 and seek care immediately.
  • This online form is not intended for appointment requests or for a service scheduled within 24 hours.
  • Rest assured that all information submitted in this online pre-registration form will be treated as part of your confidential patient record.
  • Before you start, please have your insurance card ready, and note that if you walk away from the computer for more than 10 minutes at any time, without finishing, you will have to start the registration form over. Although this may be an inconvenience, it is to ensure that your private information is protected.

If you have any trouble with the pre-registration forms, please call (207) 662-2433 or toll-free (800) 619-9715.