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

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.

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.

When arriving at the Hospital, please bring:

  • Valid Photo ID
  • Insurance card and method of payment for deductibles/co-pays and non-covered charges.
  • Paperwork from your doctor

Please remember that this is Pre-Registration. Upon arrival to your appointment other information and signatures may be required in order to complete the registration process.

Step 1 of 3

Service Information

Patient Information

Responsible Party Information

Emergency Contact Information

Primary Insurance Information

Secondary Insurance Information

The names of patients who are registered at EAMC appear in a daily directory. You have the option of having your name removed from the directory for privacy reasons. Please understand that removing your name means that if anyone calls for you, if flowers are delivered for you, or if someone comes to try to visit you at the hospital we will tell them that you are not here.

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.