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Home  » For Patients  » Online Pre-Registration

Patient Pre-Registration
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Online Pre-Registration
Le Bonheur Pre-Registration

Thank you for choosing Le Bonheur Children's Medical Center. For your convenience, we offer online pre-registration for your hospital stay, outpatient procedure or Same Day Surgery appointment. Please fill out the Online Pre-Registration Form at least two (2) full business days before your child's scheduled visit.

Please select one of the following choices to begin your pre-registration process:

How It Works

  • Your Online Pre-Registration form must be submitted at least two (2) full business days before your child's procedure. If you are pre-registering less than two full business days before your child's appointment, please call Admissions during regular business hours.
  •  Once we receive your online form, our Admissions Department will process your pre-registration. We may contact you later if we need additional information or clarification.

Before You Begin Registration

To complete your registration form, you will need several pieces of information, including personal information, employer and physician information and insurance plan/payment information. 

  • Patient Information: name, address, phone number(s), Social Security number, date of birth
  • Patient Employer Information (if applicable): employer name, address, phone number
  • Alternate Contact Information: name, phone number(s) of contact person (preferably, someone who does not live at your address)
  • Your Physician Information: name of your primary care physician or family physician.
  • Insurance Information (if applicable): Insurance company name, address, subscriber’s name, Social Security number, policy ID number and Group ID number (this is information shown on the subscriber’s insurance card).
  • Financially Responsible Person information (name, address, Social Security number, date of birth, phone number(s), employer name and employer address)
  • Accident details (if the services you’ll be receiving are related to a recent accident): description of accident, including date of accident/injury, liability insurance company name, address and phone number.

Al Out 

On November 15, Le Bonheur will become a Tennessee Tobacco-Free facility. Click here to learn more.

In the interest of improving the health of our community and serving as role models for healthy lifestyles, we havecommitted to implement a tobacco-free campus policy system-wide (no smoking is allowed inside the hospital or anywhere outside on Le Bonheur or Methodist Le Bonheur Healthcare property).

This is part of a city-wide initiative involving nearly every hospital in our area, including Baptist, St. Francis, the MED, Delta Medical Center, Memphis Mental Health Institute, the VA Medical Center and Southern College of Optometry.  St. Jude is also participating on its hospital campus.

 

 
Posted: May 8, 2006
 
For more information please contact: Bob Batson, 901.287.5306
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  Le Bonheur Children's Medical Center is a leading children's hospital in the Mid South, providing pediatric care to children from 95 counties in six states. 50 N. Dunlap Street, Memphis, Tennessee 38103 • (901) 287-KIDS