The following, secure form gathers the same information that you would otherwise
have to provide at the hospital. Please note: This form will take approximately
15 minutes to complete. You will still need to sign medical and consent forms when
you arrive at the hospital.
The information you submit is held in strict confidence by Providence Health & Services
and used only for internal processing. Please submit your complete form at least
3 business days prior to your scheduled procedure/admission date.
Questions or concerns?
Please call (503) 215-9565 or send us an
You can currently pre-register at the following facilities:
- Providence Milwaukie Hospital
- Providence Newberg Medical Center
- Providence Portland Medical Center
- Providence St. Vincent Medical Center
- Providence Willamette Falls Medical Center
- Providence Medford Medical Center
- Providence Hood River Medical Center
- Providence Seaside Hospital