Skip to Content

Section Menu

Pre-Registration Form

Patient Pre-Registration

At Trinity Mother Frances Hospitals and Clinics, our goal is to provide high quality and efficient care. For your convenience, we offer tools online that help streamline the registration process for both hospital and Trinity Clinic services. Your information is protected by law and will be used solely to register you for services.

Pre-Registration for Trinity Clinic Patients

Trinity Clinic patients can save time at check-in. Please print out and complete the following forms and bring them with you to your appointment. If you have any questions about your scheduled appointment, please call your provider's office.

View our registration packet. Please print out and complete the forms and bring them with you to your scheduled appointment.


    Please note:
  • Patients who complete this form in advance will still need to be checked in at the clinic to finalize registration.
  • Please bring your insurance cards, photo I.D. and a list of medications you are currently taking.
  • You may be contacted by the facility in advance of your scheduled appointment to obtain or provide additional information.

Pre-Registration for Hospital Services

Patients scheduled for testing, surgery, child birth or rehabilitation, please fill out the confidential form below. If you have any questions about your scheduled procedure, please call our pre-registration line at (903) 531-5335 or (800) 269-6807. We are available to take your call on weekdays from 8 a.m. to 8 p.m.


Use this form ONLY IF your procedure:
  • Has already been scheduled AND/OR
  • It is maternity related


Please note:
  • You should complete the pre-registration form 72 hours prior to your visit.
  • Patients who complete this form still need to go to the Registration/Admissions office to finalize registration.
  • Please bring your insurance cards and photo I.D.
  • You may be contacted by the facility in advance of your scheduled procedure to obtain or provide additional information.
* Denotes required fields

Patient Information

If selecting SURGERY, please view the PASS page before your scheduled procedure.
* Are you employed?

Guarantor/Insured Information

Guarantor or Insured is the person whose insurance will cover you. If private pay, provide responsible party's information.
If Private Pay, check this box

Emergency Contact

Insurance Information

* Do you have any other insurance coverage?
* This visit is related to:

Bring some cheer!

Make a patient's day by visiting, sending an eCard, or purchasing a gift!