Owensboro Health Regional Hospital Preregistration Form

* Denotes required fields

Patient Information

* Legal First Name

Legal M.I.

* Legal Last Name

Names Also Known As

Preferred Name

* Address

* City

* State Example: NY

* ZIP Code Example: 12345

* Primary Phone Example: 123-123-1234 x123

* Primary Phone Type

* Alternate Phone Example: 123-123-1234 x123

* Alternate Phone Type

Do you have an email address?

* Communication Preference

* Date of Birth mm/dd/yyyy

* Social Security Number Example: 000-00-0000

* Gender

* Race

* Primary Language

* Marital Status

* Religion

* Do we have your permission to tell your church that you are here today? This means they will be given your name when they visit.

Specific Place of Worship Attended

* Primary Care Provider/Medical Doctor

* Employment Type

Prepare for your stay at Owensboro Health Regional Hospital by reviewing our Patient & family guide.

mychart login screen

With MyChart You Can:

Schedule appointments.
View upcoming appointments, test results, immunization records and summaries of medical visits.
Request prescription renewals.
Send a message to your provider.

Get directions, find patients, and learn about amenities at the hospital, health information any time of day.

24 Hour Health Info Line
855-417-8555

Information Desk Line
270-417-3118

Not all health-related problems happen during your physician’s office hours. That’s why Owensboro Health created the Call Center , to answer your health-related questions 24/7.