Thank you for choosing Memorial Hospital. We want to make your experience here as
convenient and efficient as possible. Our Pre-Registration Program allows the hospital
to obtain all necessary registration and insurance information prior to your arrival.
You can take advantage of the Pre-Registration program in one of two ways. Please
complete the secure on line registration form below or call us directly at 717-815-2351
Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 12 p.m.
If you choose to register on-line please do so 48 hours before your expected arrival
time. You will also need the following information with you before you begin.
*Your insurance card(s), including Medicare or Medicaid
*Your physician's written order form
*Your Social Security Number
*Your Employment Information
*Emergency Contact Information
*Primary Insurance Holders Date of Birth and Employer Information
Once we receive your Registration form, if additional information is needed you
may be contacted by a Pre-Registration Specialist.
This online form is not for emergency visits. Anyone seeking emergency medical
attention will be registered in our Emergency Department upon arrival.
Date of Birth:
Guardian/Guarantor Employment Information
Insured/Subscriber's Date of Birth: