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Download and complete the forms

Maternity Other
Medicare Self Pay Anthem/Blue Cross Blue Shield Other Medicare Self Pay Anthem/Blue Cross Blue Shield Other
General Conditions of Admission
Preregistration Form
TB Screening/Latex Allergy Screening
Message from Medicare
Medicare Secondary Payer Questionnaire
DSH Application
Message from Anthem/Blue Cross Blue Shield

Please fill out the forms as completely as possible. If you are unable to answer a question, call us at (270) 745-1398 and a Preregistration Representative can help you. Or, leave it blank and we will assist you when you arrive at The Medical Center.

In order to complete these forms, you will need to review the Patient Handbook (pages 5 through 16) for the following information: Patient's Rights and Responsibilities, Patient and Family Education for Pain, Advance Directives and AIDS Education and Awareness.


Submit your preregistration forms

Please make a copy of a photo ID, Physician Order, and Insurance Card and include these in the packet with the forms listed above. There are three methods to deliver these documents to our registration staff:

  • Fax the complete packet to 270-796-2178. Please print the fax coversheet listed above and place a check by each document that is included in the packet you are faxing. Please do this at least 24 hours before arriving at The Medical Center to ensure that your Pre-Registration is complete before your arrival.
  • Mail the entire packet to:
    The Medical Center
    ATTN: Kim Gipson
    250 Park Street
    Bowling Green, KY 42102-8907

    Please do this at least 72 hours prior to your arrival to ensure that our staff has ample time to receive the documentation and complete your Pre-Registration.
  • Bring your documentation with you on the day of your visit. You will not be Pre-Registered with this method, but you will speed up the registration process with your documentation filled out on arrival.

    You will be notified by email or phone call that your Pre-Registration is complete and may be given an account number for your visit. Please bring this confirmation email or account number with you the day of your visit. If you have not heard from our staff by the day of your visit, please call 270-745-1398 to inquire about your status.

The day of your procedure

While the preregistration process cuts down on the registration time, there is still some important information you will need to bring with you the day of your procedure to complete registration.

  1. Identification (such as a driver's license)
  2. All health insurance cards
  3. Certifications and claim forms
  4. Any physician's orders
  5. Test results given to you by your physician's office