Thank you for choosing Lake Health for your upcoming surgery, procedure, or test. By completing this form online, you will save time when you arrive at our facility the day of your procedure or admission.
Please note the following:
- This online form is for Lake Health only and will not be accepted by any other health care facility.
- Lake Health respects the right to privacy and confidentiality of all patients.
- The information you provide will remain secure and will be used strictly for your medical record and insurance verification purposes.
- You might still need to stop in the Patient Registration department at the time of your visit to sign any documentation that might be needed, in addition to bringing insurance cards and co-pays if applicable.
- If your form is incomplete or needs clarification, the Patient Registration staff might need to conplete your registration either by telephone or in person when you arrive at our facility.
- Medicare subscribers must provide additional information in person at the time of the visit.
- After you complete your form, click on the "Submit" button, and it will be transmitted securely to our Patient Registration department. This advance registration form must be received by Lake Health's Patient Registration department at least three business days before your scheduled visit.
- At the time of check-in, we will estimate your financial responsibility based on your insurance benefits. If you have a co-pay, we will accept it in cash, check, or credit card.
- For Physical Therapy and Occupational Therapy forms, click here.