Welcome to Community Medical Centers' patient pre-registration form. Please click on each of the sections below and fill out all required information. A green checkmark will appear next to sections you have already completed. When you have completed each section, a submission button will appear at the bottom of this page to allow you to submit your information to us.

Once you complete this form, you will get a confirmation call from staff to complete the second portion of the registration, to sign all documents, and provide an insurance card and photo id.

Please do not leave the Community website or close your browser before you submit your form or your information will be lost and you will have to complete the form again from the beginning.