Patient Pre-Registration Forms
Thank you for choosing El Campo Memorial Hospital and/or MidCoast Medical Clinic for your next medical visit. By completing this pre-registration form, you can receive peace of mind that we have your medical information for your upcoming services.
Complete the following information as accurately as possible. This form should take 4 or 5 minutes to complete. To submit your information simply click the "Submit Form" button to complete your pre-registration process. (*) Required information is necessary.
Please note - one set of forms is clinic pre-registration. The other set of forms is hospital pre-registration. Please make sure to select the correct form that applies to you.
Pre-Registration not available for weekend clinic appointments.