* Instructions
* Printable Form (pdf)
Do you currently have an appointment?
This form must be completed at least one business day
prior to service in order for the pre-registration to take place.

Service Date


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<July 2020>
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Reason for visit


Facility
* means required
PATIENT PERSONAL


Month   Year  
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<July 2020>
SunMonTueWedThuFriSat
2829301234
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PATIENT EMPLOYMENT


GUARANTOR (IF PATIENT UNDER 18, PARENT INFORMATION)

  
Month   Year  
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<July 2020>
SunMonTueWedThuFriSat
2829301234
567891011
12131415161718
19202122232425
2627282930311
2345678
EMERGENCY CONTACT


ACCIDENT / INSURANCE INFORMATION


Month   Year  
Close
<July 2020>
SunMonTueWedThuFriSat
2829301234
567891011
12131415161718
19202122232425
2627282930311
2345678

Month   Year  
Close
<July 2020>
SunMonTueWedThuFriSat
2829301234
567891011
12131415161718
19202122232425
2627282930311
2345678

 



Online Pre-registration for Outpatient Diagnostic
and Surgical Procedures
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This form is only for those with a currently scheduled appointment with a Tanner Health System related facility. If you need to confirm that you have an appointment, please call 770-836-9721.

This form must be completed at least one business day prior to service in order for the pre-registration to take place.

Insurance and employment information regarding you (and your spouse if applicable) will be required to fill out the form.

Filling out this form should take 10 to 15 minutes. If you do not wish to complete and submit the form online, you may click here for a copy formatted for printing. Once you have printed out the form, you may fill it out and either FAX it or bring it with you to registration.

Regardless of how you pre-register, you will still need to bring your photo ID and insurance card with you to check-in at the time of your appointment. You will be asked to sign consent forms and address any copay or deductible issues when you check in at your designated facility.

Thank you for choosing Tanner Health System

Thank you for completing the online pre-registration form. Close

Tanner Health System


© 2020 Tanner Health System