Before you begin...
If your service is within one business day of today, please pre-register by calling (574) 725-3500 or (800) 243-4512 x-3500.  Hours are from 8am to 6pm Monday thru Thursday and from 8am to 5pm on Friday.

If you need assistance with a part of the process, please call the pre-registration call-in line at the numbers listed above.  Our registration staff will be glad to assist you.

Enter as much information as you can so your check-in process will be as streamlined as possible.

On the day of your services, please bring your insurance card(s) with you.  Check in with the Concierge at the Information Desk located in the Main Lobby.  It's important that you pre-register at least twenty-four business hours before your scheduled service.

(The yellow shaded areas below are required fields.)
 

E-mail is not a secure form of communication, and privacy of information contained in the e-mail cannot be guaranteed. Memorial Hospital is not responsible for any harm or damage you may experience or incur by sending personal or confidential information using this website.  By supplying an email address with this form you will receive a confirmation, we cannot guarantee it's security.  An email address is optional and not required.