Pre-Register

Thank you for choosing Baptist Health for your care.

To save you time, we offer the ability to submit your paperwork prior to your scheduled appointment using the following pre-registration form.

For your privacy, all information is securely transmitted to only authorized Baptist Health personnel. You will need to complete the form fully before leaving the pre-registration form window. Your progress will not be saved, and all information will be lost if you close this window before fully completing the pre-registration form. If you do not wish to use the online pre-registration form, you can download a print version to bring with you to your appointment.

Please note: pre-registration is not a request for an appointment. If you need to request an appointment, please call Baptist Health HealthLine toll-free at 1-888-227-8478.

 

Step 1 of 4

If yes, please call 501-202-2875 to provide further information.
If yes, please call 501-202-2875 to provide further information.
e.g. XXX-XXX-XXXX
- -
e.g. MM-DD-YYYY
e.g. XXX-XXX-XXXX

Your Information