Pre-Registration

Thank you for pre-registering on-line for either inpatient care or outpatient services. The form is very easy and secure.

Pre-registration must be completed at least 24-hours prior to your scheduled appointment. Thank you.

By agreeing to the terms of our secure forms, you will enter a secure area of our web site. Massena Memorial Hospital will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other third parties. The information will solely be used by Massena Memorial Hospital.
Your request will be processed within 24 hours, during normal business hours, Monday - Friday, 7:00 am - 4:30 pm, excluding holidays.

If you have any questions regarding the use of the pre-registration form, please contact our office during normal business hours. If you need assitance in completing the form, please call MMH Patient Financial Counseling Department at 315-769-4241.

To access the Online Registration please continue below with the form. Thank you!

* = Required Field

Patient Information
  • MI:
  • Zip: *

  • (format "MM/DD/YYYY")
Visit Information

Your registration is not complete until a clerk has called you for the additional required information.

Please Bring the Following with you:
1. Photo ID
2. Insurance Card
3. Doctors Order
 
 

 

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April 2014

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