Pre-Registration Form


Submit online Pre-Registration at least 72 hours before your procedure or service. Click on the button below to go to the pre-registration form.

Welcome to the East Alabama Medical Center Online Pre-Registration Service.

For your convenience, you may Pre-Register for your upcoming visit by completing the online pre-registration form. When using the Pre-Registration service, please allow sufficient time for us to process your request. Pre-Registration submitted less than 72 hours before arrival may not be processed before you arrive at EAMC.

When arriving at the Hospital, please bring:

  • Photo ID with current address.
  • Insurance card and method of payment for deductibles/co-pays and non-covered charges.
  • Orders and paper work from your Doctor.
  • Print and complete the following medication form. Click here for more information.
Medication Form English | Medication Form EspaƱol

Note: If you are a surgery patient please call 528-1215 to schedule an appointment for pre-surgery registration if physician indicates you will need pre-operative lab work.

Keep in mind that this is Pre-Registration. Upon arrival at the hospital your signature will be required in order to complete the registration process.

The Patient Registration Department of East Alabama Medical Center strives to provide the highest quality customer service while obtaining accurate patient data. We will work with other departments in our facility to meet the overall needs of our patients while providing easy access to our services.
We understand that your privacy and security are of the utmost importance. For your peace of mind, your registration information is secure while being transferred to EAMC utilizing 128 bit Secure Sockets Layer (SSL) technology. This technology encrypts all of your personal information including social security number, name and address, so that it cannot be read as the information travels over the Internet.
If you are experiencing technical problems submitting this online form, please contact EAMC Technical Support at (334)528-6850.