If possible, please complete this form at least 2 business days prior to your scheduled procedure.
The following items will help with the online pre-registration process:
Name of physician who ordered the procedure.
Date of the scheduled procedure.
Personal, employment, and contact information.
Insurance information. Please have your insurance card(s) available.
The online pre-registration process should take no longer than 15 minutes to complete. You will receive a confirmation page and confirmation email.
If you have any questions, please contact Pre-Registration at 217-347-1371. Our office hours are Monday-Friday, 6 a.m. to 6 p.m.