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312 9th Street SW, Waverly, Iowa 50677

(319) 352-4120

Pre-registration

Thank You for choosing us for your health care services. As a convenience, we offer online hospital pre-registration. We encourage you to preregister for scheduled services to ensure a quicker check-in process.

Note: Please pre-register at least 24 hours before your appointment.

Please fill out the entire form to the best of your ability. If there is no answer, enter N/A. Fields marked with an asterisk (*) are required.

Items You Will Need for Online Pre-Registration:

  • Active insurance cards
  • Patient and insurance subscriber’s Social Security numbers
  • Physician order & physician’s information including (names, addresses, and phone number)
  • Emergency contact information

Items You Will Need on Day of Admission:

  • Active insurance cards
  • Picture ID (Driver’s license)
  • Physician order
  • Co-payment/deductibles are expected at time of service unless prior arrangements are made. (We accept MasterCard, Visa and Discover cards)

Contact Us

Phone (319) 319-4120
Manager Becky David

Please use this form for hospital pre-registration only. This is not used for clinic visits.