Emergency Department

202 S. Park St.
Madison, WI 53715

7 min Average

Hospital Pre-Registration

If you will soon be admitted to UnityPoint Health – Meriter for a planned hospital stay, we suggest that you fill out our Hospital Pre-Registration Form by clicking the link on the right. This online form is secure and HIPAA compliant. Filling out the form in advance will minimize your admission time and assist with your financial arrangements. Please submit this form at least 3 business days before your admission date.

If you have been a patient at Meriter in the past year, it may be more efficient to call Patient Registration to verify and update your information, instead of filling out this form. The Patient Registration staff can be reached at (608) 417-6020. The office is open Monday-Friday, 7 A.M. - 6 P.M.

Please call Patient Registration at 608-417-6020, Monday – Friday between the hours of 7 A.M. - 6 P.M.

Patient Information


Employment Status (if applicable)

Spouse or Next-of-Kin Information

Insurance Information

Primary Insurance Company

Other Information

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