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Pre Registration

Online Pre-Registration Form for McLaren Greater Lansing
This is a secured webpage.



















 









* Indicates required information



















 


Section 2:

 

 



Section 3: Patient Demographic information
















 










 

 

 



 



 





 















 





Emergency Contact Information:



 


 

 
 





 


If patient is a minor, information for responsible party:  
 





 

 

 



 



 



   
Section 4: Insurance Information
 






 






 




 



 




 


 











 




 



 


 













 



 



 







 


 







 


 
Is the accident or injury:




   
Section 5: Questions we are required to ask  
   
If someone calls to verify you are at McLaren Greater Lansing, we will confirm your room number, telephone number and condition (stable, critical, etc.)
   
You have the right to OPT OUT of the facility directory and have no information disclosed.
   
By answering no, your name will not be included in the facility directory. That means that you are responsible to inform friends and family members regarding your location in the hospital.
   
By answering no, if a someone calls or inquires about you at the information desk, we will state "we have no information."
 
Do you want to be included in the facility directory?




 
Do you have a Durable Power of Attorney or Advance Directive for health care?





Would you like to receive information on Durable Power of Attorney and Advance Directives?
 





Do you wish to receive confirmation that your pre registration was processed?  *