Save time with our online form
Thank you for choosing Lake Health for your upcoming surgery, procedure or test. By completing this form online, you’ll save time when you arrive at our facility the day of your visit.
- This online form is for Lake Health only and will not be accepted by any other health care facility.
- Lake Health respects all patients’ right to privacy and confidentiality.
- The information you provide will remain secure and will be used strictly for your medical record and insurance verification purposes.
- You might still need to stop in the Patient Registration department at the time of your visit to sign any documentation that might be needed, in addition to bringing insurance cards and co-pays if applicable.
- If your form is incomplete or needs clarification, the Patient Registration staff might need to complete your registration either by phone or in person when you arrive at our facility.
- If you’re a Medicare patient, you must provide additional information in person at the time of your visit.
- After you complete your form, click on the “Submit” button, and it will be transmitted securely to our Patient Registration department. This advance registration form must be received by Lake Health’s Patient Registration department at least three business days before your scheduled visit.
- At the time of check-in, we will estimate your financial responsibility based on your insurance benefits. If you have a co-pay, we will accept it in cash, check or credit card.
- For Physical Therapy and Occupational Therapy forms, click here.
- To review Lake Health's Authorization for Disclosure of Health Information form or request your medical records, click here. A Release of Information Office is located at all Lake Health System Facilities. The telephone numbers for the hospital offices are 440-953-6070 West and 440-375-8365 TriPoint.
If you have any questions, please call 440-953-6258 Monday through Friday from 8 am to 7 pm.