Pre-admission Registration Form

If you will soon be admitted to UnityPoint Health - Meriter for a planned hospital stay, we suggest that you fill out our online Pre-admission Registration Form. Please note this form is secure and HIPAA compliant.  This will minimize your admission time and assist with your financial arrangements. Please submit this form at least 3 business days before your admission date.

To assist you in filling out this secure form, please gather your physician, employment, emergency contact and insurance information. This form will take about 15 minutes to fill out. If you do not complete all pages in the form and click the Finish button at the end, your information will not be saved.

If you have been a patient at UnityPoint Health - Meriter in the past year, it may be more efficient to call Patient Registration to verify and update your information, instead of filling out this form. The Patient Registration staff can be reached at (608) 417-6020. The office is open Monday-Friday, 7 a.m. - 6 p.m.

Please Note:
Online registration is our preferred method of registration. However, if you would prefer to register over the phone, please call our staff at (608) 417-6020. Our office is open Monday-Friday, 7 a.m. - 6 p.m. They are also glad to answer any questions you may have.