Patient Pre-Registration

Published On 07/11/2011

Thank you for choosing Le Bonheur Children's Hospital. For your convenience, we offer online pre-registration for your hospital stay, outpatient procedure or Same Day Surgery appointment. Please fill out the Online Pre-Registration Form at least two (2) full business days before your child's scheduled visit.

Please select one of the following choices to begin your pre-registration process:

How It Works

  • Your Online Pre-Registration form must be submitted at least two (2) full business days before your child's procedure. If you are pre-registering less than two full business days before your child's appointment, please call Admissions during regular business hours.
    •  Le Bonheur Children’s Hospital, 848 Adams Ave., Memphis, TN, 901.287.5567
  •  Once we receive your online form, our Admissions Department will process your pre-registration. We may contact you later if we need additional information or clarification.

Before You Begin Registration

To complete your registration form, you will need several pieces of information, including personal information, employer and physician information and insurance plan/payment information. 

  • Patient Information: name, address, phone number(s), Social Security number, date of birth
  • Patient Employer Information (if applicable): employer name, address, phone number
  • Alternate Contact Information: name, phone number(s) of contact person (preferably, someone who does not live at your address)
  • Your Physician Information: name of your primary care physician or family physician.
  • Insurance Information (if applicable): Insurance company name, address, subscriber’s name, Social Security number, policy ID number and Group ID number (this is information shown on the subscriber’s insurance card).
  • Financially Responsible Person information (name, address, Social Security number, date of birth, phone number(s), employer name and employer address)
  • Accident details (if the services you’ll be receiving are related to a recent accident): description of accident, including date of accident/injury, liability insurance company name, address and phone number.