Patient Registration

To pre-register electronically for your upcoming procedure, please provide the requested information on the five following areas:

1 - Patient Information
2 - Emergency Contact Information
3 - Insurance Information
4 - Billing Information
5 - Procedure Information

After providing the information, use the submit button to submit the pre-registration information. Please wait until you are redirected to the confirmation page, before taking any further action. We hope you find this form easy to use and beneficial to your admission process at Springhill Medical Center.

1 Patient Information

Employer Information

2 Emergency Contact Information

3 Insurance Information

Primary Insurance Information

Secondary Insurance Information

4 Medical Charges

Person Responsible for Hospital Charges

5 Procedure Information

Anticipated date to be admitted to Springhill Medical Center?

6 Review

Please review the information you have entered to ensure it is accurate before submitting the registration.

* It is extremely important that you bring your Driver's License, Insurance cards, and Physician Orders at the time of your service.

Please feel free to contact the Pre-Registration Office at 251.460.5240 at any time between the hours of 8:00 a.m. - 5:00 p.m. on Monday-Friday, if you have any questions about your registration or if we may be of assistance to you in completing this form.