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.

El Campo Memorial Hospital (ECMH) and its predecessor have been providing the highest quality medical care in El Campo for over 68 years, and at the current location since 1979.The hospital is accredited by state and federal regulations (Medicare/Medicaid). Patient Billing: Various physicians involved in your care at ECMH will bill you directly for their services. These may include your anesthesiologist, emergency room physician(s), radiologist, pathologist, cardiologist or other consulting physician during your ER visit or hospital stay. Please remember that some physicians are private practitioners (contracted by ECMH and not an actual employee of ECMH) and may not be a provider on your specific managed care plan.