Please complete this form at least 24 hours before your visit to allow adequate time for processing your information.
If your appointment is within 24 hours, please use phone pre-registration: 812-375-3718 or 1-800-841-4938 ext. 3718. Phone registration is available Monday - Friday from 9 AM - 8 PM.
A confirmation email will be sent that will have directions on where to go upon arrival to the hospital.
Remember to bring your insurance card(s) and photo ID with you.