Registration & Forms

REGISTRATION & FORMS

Thank you for choosing Monroe Hospital for your healthcare needs.

Save time! Pre-register

When you arrive at the hospital for your procedure, you will be greeted and brought to the Registration Office by one of our friendly registration staff. During the registration process, you will be asked several questions, including but not limited to the following:

  • Name
  • Address
  • Social Security Number
  • Date of Birth
  • Phone Number
  • Emergency Contact Name
  • Emergency Contact Phone Number
  • Name of Primary Care Physician
  • Employer Information

Please also be sure to bring the following items with you to your appointment:

  • Photo ID (MUST HAVE)
  • Insurance Cards (MUST HAVE)
  • Handwritten order from physician’s office (if available)
  • A list of all current medications

Pre-Registration:

To save time and pre-register for your procedure, you can download a copy of the registration form and fax it to the phone number listed below. If you wish to pre-register, you must do so at least 48 hours prior to your scheduled appointment.

*Please note: Even if you pre-register, you will be asked to verify much of the information upon your arrival at the hospital for your procedure. You will also need to present your insurance cards and a photo ID at this time.

** You do not need to pre-register for any walk-in procedures such as lab work or X-Rays.


For any questions, or to fax your pre-registration information please call

Phone: (812) 825-1111
Fax: (812) 825-0760