You can speed up your registration process by preregistering online. Enter the information requested below as completely and as accurately as possible. The form must be completed two business days prior to your admission.
If you have any questions concerning the online preregistration process, please call 605-353-6233 or 1-800-529-0115 ext. 233.
If you have already completed this form but need to provide insurance information, click here.
Please Note: Any information collected during the online preregistration process is protected for your privacy and confidentiality.
* Fields are required.
Under the Age of 18 Information
Please complete if patient is under 18 years of age:
Please complete if applicable:
Emergency Contact Information
Important Note: Please click the Submit button below only once. It may take a few moments to process this page. On the next page, you will be asked to complete insurance information for the insurance type(s) selected above.