Emergency Contacts HELP

This is Help for the current pre-registration page. This Help describes the buttons and fields on the page, the information that goes in the fields, and how to enter the information.

Note: Some pre-registration information is required. If you see this mark * before a question or statement on the pre-registration page, it means you must provide the requested information. If you do not provide the information, you will not be able to complete the pre-registration process online. You will have to go through the process by telephone instead.

Primary Emergency Contact
This is the person we will contact in an emergency while the patient is in our care at our facility.

If you do not want to enter information on the primary emergency contact during this preregistration process, click the box.

If you want to enter the information now, do not click the box. Instead, continue by entering the information in the fields.

Secondary Emergency Contact
This is the person we will contact in an emergency if we cannot get in touch with the primary emergency contact.

If you do not want to enter information on the secondary emergency contact during this preregistration process, click the box.

If you want to enter the information now, do not click the box. Instead, continue by entering the information in the fields.

Go back  button
Click this button to return to the previous pre-registration page.
Continue  button
Click this button when you have finished entering the information on the current page and are ready to continue with the pre-registration process.
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