Inpatient and Surgical Pre-Registration Form :: Nationwide Children's Hospital

Pre-Registration for Inpatients and Outpatient Surgery

To better serve you, Nationwide Children's Hospital offers a secure, online pre-registration form (for inpatients and outpatient surgery only) before you arrive. The form requires you to provide standard information and should only be completed if you have a scheduled inpatient admission or scheduled outpatient surgery to Nationwide Children's Hospital. Please be prepared to present your most current insurance card when you come to the hospital.

Key areas of information for the online form include:

  • Patient/Child information
  • Information about the attending physician (specialist at Nationwide Children's Hospital who will be performing the test/procedure)
  • Information about the physician who has recommended that your child see the specialist
  • Information about your Primary care physician (pediatrician or family doctor)
  • Appointment Information/Chief complaint
  • Payment Information/Insurance card information (it is recommended that you verify your benefits prior to the completion of this form and always bring your card with you to the hospital)
  • Parent/Legal guardian information
  • Emergency contact information

Fill out pre-registration form for
inpatient admissions & Outpatient surgeries

The registration form is within a secure area of the website, which allows Nationwide Children's Hospital to protect all your personal information.

If you have any questions about the form or the online pre-registration process, please contact Patient Access at (614) 722-2210 or email us at: admittingmail@NationwideChildrens.org.

Answers to many questions regarding admitting and insurance are also available via the Admitting Questions link to the left.

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000