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Patient Pre-Registration

Patient pre-registration is an easy, time-saving service that allows you to pre-register for many medical services at your convenience. Your paperwork is already filled out when you arrive for your appointment. Download and print our patient pre-registration forms before you arrive.

If you have any questions while completing your pre-registration, call us and we will help you through the process. We're available Monday – Friday, 7 a.m. – 5 p.m., at 800-807-7667.

How to Pre-Register at Lima Memorial

Here is what you will need in order to pre-register:

  • Download the patient pre-registration forms to fill out.
  • Your insurance ID card.
  • Social Security number and date of birth of the insurance cardholder.
  • Procedure date and time.
  • Type of procedure (such as a mammogram or X-ray).
  • Personal contact information.
  • Your doctor’s order.
  • Fax your completed form to 419-221-6148

Preparing for Your Medical Procedure

Be sure you fax your completed form to 419-221-6148 at least 24 hours before your appointment.

Bring a printed copy of the patient pre-registration form, your doctor's order and your insurance card on the day of your procedure.

Depending on the medical procedure scheduled, your form may list additional items you should bring to your appointment.

You will need Adobe® Acrobat® Reader to view PDF documents. Download a free copy from the Adobe Web site.