Congratulations on your upcoming delivery! It's recommended you pre-register for your hospital stay by completing the maternity pre-admission form below a couple of months prior to your due date.
If you have already registered in person at the hospital, please do not complete the electronic pre-registration.
After the information submitted through the electronic pre-registration form has been processed, you will receive a phone call from YRMC's Patient Access department with a confirmation number.
When you are ready to deliver and arrive at the hospital, a registrar will confirm the registration information with you. You will also be asked to sign a consent form upon arrival. Please remember to bring to the hospital:
Note: A deposit is required for self-pay patients, or if you are insured but your procedure is not covered by your plan. Please contact the YRMC Patient Access department at 928-336-7614 before your expected date of arrival.
Preserving the confidentiality of your personal information is important to YRMC. This e-registration form is secure, and the personal information you send through it will be kept confidential by YRMC's encryption technology.
If Other, please specify: