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Methodist Emergency Department

First Available Time :

Pekin Emergency Department

First Available Time :

Proctor Emergency Department

First Available Time :

Pekin Urgent Care

First Available Time :

Proctor First Care - East Peoria

2535 E. Washington St.
East Peoria, Illinois 61611

00 Patients
Waiting Now

Proctor First Care - Peoria Heights

1120 E. War Memorial Drive
Peoria Heights, Illinois 61616

00 Patients
Waiting Now

UnityPoint Clinic - Express

1909 North Morton Avenue
Morton, Illinois 61550

00 Patients
Waiting Now

UnityPoint Clinic - Express

8914 N. Knoxville Avenue
Peoria, Illinois 61604

00 Patients
Waiting Now

UnityPoint Clinic - Express

209 N. Cummings Lane
Washington, Illinois 61571

00 Patients
Waiting Now

Birth Care Pre-Registration

Please complete this form at 18-20 weeks in your pregnancy.

Birth *
Delivery Method
Would you like to receive our birthcare information by mail or email?

Patient Information


Marital Status
Race
Translation/Interpreter Services Needed?
Spiritual needs are important to some patients, would you like us to notify your faith community leader of your admission?

Mailing Address


Employment Status (if applicable)

Emergency Contact Information



Mother's Insurance Information



Mother's Secondary Insurance


Secondary Insurance? (If yes, please complete section)

Baby's Insurance Information


Is the baby's insurance the same as the mother/carrier? *

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