This downloadable Emergency Patient Registration Form is used for quick identification purposes only. This form may be presented at one of the St. Luke's Community Emergency Centers® or main hospital campus Emergency Departments.
Due to the nature of emergency services, patients are seen in order of medical need and not the time of arrival. It is helpful for any registration to have photo identification of the patient with you, for example, a Drivers License, if available. If you wish to use medical insurance, bring a current insurance identification card as well. If a child or minor is the patient, having the minor's Social Security Number helps ensure correct identification for this and future visits. Emergency Room CoPay or CoInsurance is required by most insurance plans. Amount varies based on your plan.
You may download the Patient Registration Form and fill it out before you arrive.
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