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.
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
Note: After clicking the Submit button below, you will then be asked to complete insurance information for the insurance type(s) selected above. If insurance information is not provided on the next page, your preregistration will not be able to be processed.