Pre-registration

Thank you for choosing New Hanover Regional Medical Center for your healthcare needs.  To help expedite the admission / registration process we encourage you to complete the appropriate pre-registration forms provided below.   If you know you are going to be a patient, it can save time to fill out the registration forms in advance of your visit.  After completing and printing the forms, please mail or fax them as directed below, or bring them with you on the day of the procedure.

Send forms via fax to: 910.667.7379

Send forms via mail to: NHRMC Business Center Annex 2001 S. 17th Street - Pre-Registration Dept. Wilmington, NC 28402

Please be sure to use the appropriate form below. 

Acrobat Reader is required to view and print the forms provided above.  If you are having trouble opening the forms, then click here for the free Adobe Acrobat Reader download. 

On the Fill-In forms be sure to complete all of the required fields marked with a red border.  If required fields are not filled in your pre-registration may not be processed.  If you need to stop and come back to the form at a later time to complete it, you can save the form to your computer to finish later.   

Pre-Registration Forms:

• Standard Pre-Registration Form
• Child Pre-Registration Form (for patients under 18 years of age)
• TriCare/Champus/Champus VA Pre-Registration Form
• Worker's Comp Pre-Registration Form

Other Forms

• Patient Acknowledgement and Information Listing Instructions
  • Spanish version
    
• Joint Notice of Privacy Practices
  • Spanish version

 If you have questions about the forms then please call:  910.667.5546