989.723.5211 or 800.206.8706

Pre-Registration

*Denotes required fields

Pre-registration can save you time on the day of your visit.

To register for your visit to Memorial Healthcare, please follow these simple steps. Note – all fields are not mandatory. If we require additional information, we will contact you by telephone.

  1. Complete the form below as completely as possible and submit. You will receive a confirmation email upon successful submission. Note – you will be contacted by our Call Center regarding your pre-registration status.
  2. This form must be submitted no later than 48 hours in advance of your procedure.
  3. All fields marked with an asterisk are required.
  4. Please provide the Primary/Family physician, if you wish results to be forwarded to this physician as well.
  5. Please bring ALL doctor’s orders and paperwork with you on date of visit.

Thank you. If you have any questions or would prefer to register by phone, contact our Call Center at 866.900.6422.

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