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.

nurse speaking on the phone

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.