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.Additional Notes:
- 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.
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