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Pre-Registration

Prospective patients at Hancock Regional Hospital are encouraged to complete one of our pre-registration forms below. By doing this, Hospital staff can verify and pre-certify your insurance prior to your arrival -- saving you time!

Please submit ONE of these forms at least TWO days prior to your scheduled visit. Online and faxed forms may be sent 24 hours a day. If you have questions, please call the Registration Department at 317-468-4604 -- our helpful staff are available to answer your questions 24 hours a day.

Submit an Online
Pre-Registration Form

Information submitted online is transmitted using 128-bit secure encryption.

OR

Get Acrobat Reader Download and print a Pre-Registration Form (PDF)

Completed pre-registration forms may be faxed to: 317-468-4161, turned in at any Hospital Registration Area, or mailed to the address below:

Hancock Regional Hospital
ATTN: Registration Dept., Pre-Admission
P.O. Box 827
Greenfield, IN 46140

 

 

 

Pre-Registration
801 North State St. | Greenfield, IN 46140 | 317-462-5544 | generalinformation@hancockregional.org