Patient Registration 


Registration Information


Our goal is to ensure that your registration goes smoothly and with minimal delays.  The information below will help us do just that.   Please have this information available at the time of your registration or pre-registration.  Thank you.


1.      Patient legal name

2.      Date of birth

3.      Social Security number

4.      Address and phone number

5.      Insurance Card (we will need to copy the front and back)

6.      Drivers license to verify identity (we will copy this ID)

7.      Employer, date of injury and your employer’s worker’s compensation insurance carrier if your are receiving care related to a work injury

8.      If you are covered by Medicare, we will need both the patient’s and spouse’s (if applicable) retirement date

9.      Please understand that we will calculate and collect applicable co-payments and deductibles at the time of your registration

10.  A copy of your Advanced Directive will be accepted at this time


If you have questions, you may call any of the following personnel:



(805) 434-4763 or (805) 434-4765

Admitting Supervisor

(805) 434-4537

Admitting Director 

(805) 434-4796

Director Patient Financial Services 

(805) 434-4536