Pre-Registration

In order to make your visit as efficient as possible, we encourage patients to pre-register online for Labor & Delivery and Surgery services. Once registered, patients can be assured our professionals will be prepared for their visit, enabling them to complete their visit and checkout without delay. For insurance verification purposes, it is recommended that this form be submitted at least three days prior to your expected admitting date.

All patients need to stop by their designated registration area to complete the registration process. Patients are expected to pay all deductibles, coinsurance or co-payments at the time of service.

Pre-register by Phone 

You can call Mission Main Registration at 949-364-1400 ext. 1810 (Mission Viejo) or 949-499-1311 ext. 7167 (Laguna Beach) and ask one of our registrars to pre-register you over the phone. If a registrar is unavailable, please leave a voicemail and your call will be promptly returned.

Pre-register by Fax

Download and complete the Adobe Acrobat Online Pre-Admission Form and fax it to Mission Main Registration at 949-365-2306. For insurance verification purposes, it is recommended that you fax the registration form at least three days prior to your expected admitting date.

If you have any questions about our Pre-Registration Forms please call your designated registration office.

Pre-register Online


Admitting Information

MM/DD/YY or MM/DD/YYYY

Patient Information

999-999-9999
MM/DD/YY or MM/DD/YYYY
999-999-9999

Emergency Contact Information

999-999-9999

MEDICARE Patients

MM/DD/YY or MM/DD/YYYY
MM/DD/YY or MM/DD/YYYY
MM/DD/YY or MM/DD/YYYY

Accident / Injury

MM/DD/YY or MM/DD/YYYY
999-999-9999

Primary Insurance

MM/DD/YY or MM/DD/YYYY
999-999-9999
999-999-9999

Secondary Insurance

MM/DD/YY or MM/DD/YYYY
999-999-9999
999-999-9999