Piedmont Newton Hospital (General PreRegistration) > Restart Pre-Registration Process
Welcome to the Piedmont Healthcare Online Pre-Registration Application!
This process will take a few minutes. ONCE YOU BEGIN YOU MUST COMPLETE THE PROCESS. You cannot stop in the middle of the form and return later. You will have the opportunity to edit your information at the conclusion of the form. Do not use the Back button on your web browser to go back and edit the forms.
  • Do not use the "Back" button on your web browser. Use the buttons within this page to navigate through the steps of the pre-registration process.
  • This application uses pop-up windows for certain functions. If you have pop-up blocking software installed on your computer or have your web browser configured to block pop-up windows, please enable pop-ups for this site.
  • You will need your physician information, insurance information and employer information for you and your spouse to complete this Pre-Registration.
  • Complete as many of the fields as you can (required fields are labeled with a red star) and click the Continue button at the bottom right corner of each page to proceed.
  • You will have the chance to review and edit all information you have entered BEFORE your registration is finalized.
  • After your registration is complete, you will need to download additional forms to complete by hand and sign. Bring the completed forms with you to the hospital when you arrive for delivery along with your photo ID, insurance card and advance directive.
For security purposes, please check the checkbox below to verify that you are a human using our system and not a computer program or "robot". This is a security measure called a "CAPTCHA" and is a standard method used to prevent hackers from utilizing computer programs called "robots" or "bots" to flood our system with automated form submissions

Change the CAPTCHA codeSpeak the CAPTCHA code
 

Note: Please consult with your physician before going to the hospital for services.

<< Go Back Continue >>






Contact us at 1-855-677-1212 from 8am-8pm Monday through Friday and 9am-5:30pm Saturday with preadmission questions or issues