Pre-Registration

Need Help?

If you have questions about pre-registration forms, please call (910) 667-5546.

Filling out pre-registration forms before your appointment or stay can help make the admission and registration process go more smoothly. We encourage you to complete the correct forms and turn them in either by faxing, printing and mailing them, or bringing them with you the day of your procedure.


Finding and Completing Your Forms

Please find the correct form below. Acrobat Reader is required to view and print the forms. Please complete all of the required fields marked with a red border on the fill-in forms. Incomplete forms may not process.  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. 

For any questions about the forms, please call 910-667-5546.

Pre-Registration Forms:

Other Forms

Please send completed forms via fax to 910-667-7379, or mail forms to:

NHRMC Business Center Annex 
Pre-Registration Department
2001 S. 17th Street 
Wilmington, NC 28401