As a convenience for our patients, Progress West HealthCare Center is pleased to
offer online pre-registration.
Before you begin:
- If you need immediate medical assistance, please contact 911 or seek the nearest
- Please do not use this form if your scheduled hospital visit is today; if your procedure
or test is not yet scheduled, contact your physician to arrange this
- You are entering a web site that is secure; the information you view and send cannot
be read while in transit
You will need this information to complete your pre-registration:
- Your doctor’s full name
- Your Social Security number
- Your employment information
- Emergency contact information
Fill out each page. Enter as much information as you can so you will not need to
provide it when you arrive for your visit.