Facility Pre-registration

 

This is for the pre-registration of non-emergent patients only. 

If you are wanting to make a reservation for the emergency room, please visit InQuickER.

Please submit this online pre-registration at least 2 business days in advance of your hospital check-in to ensure adequate processing time.

If you choose to utilize our pre-registration form, understand that you do so at your own choice and risk. Any information you submit via the pre-registration form is confidential and is only shared with third parties as outlined in our Privacy Pledge.

Pre-registration Disclaimer
 
If you elect to electronically submit a completed Pre-registration Form or any other information to Brookwood Baptist Med Ctr through this web site, you agree that you do so at your own choice and risk, and that you assume all responsibility for any liability arising from such electronic submission and from any errors or omissions in the data you provide. You agree to release and hold Brookwood Baptist Med Ctr and its affiliates (including its directors, officers, employees, shareholders, agents and representatives) harmless from any and all liability or cause of action arising from the interception, access or use by a third party of any information submitted electronically by you through this web site and from any errors or omissions in the data you provide. Additionally, the provision of any information to Brookwood Baptist Med Ctr by you through this web site, including a completed Pre-registration Form, does not create or constitute any relationship between you and Brookwood Baptist Med Ctr, its affiliates, or any of the physicians on its staff, to which any privilege may attach.