Pre-Register for Your Hospital Stay

Please utilize the form below to pre-register for your procedure for CHRISTUS Santa Rosa Health System in San Antonio and New Braunfels, Texas, CHRISTUS Children's, CHRISTUS Southeast Texas, and all CHRISTUS facilities in Louisiana.  For all other locations, please login or create a MyCHRISTUS account.

 

CHRISTUS Facility

General Patient Information

Test/Procedure

Emergency Contact Information

Guarantor/Responsible Party Information

(If different from above)

Patient Insurance Information

Enter Not Applicable (N/A) if self pay

Please bring insurance card and photo ID

Patient Secondary Insurance Information

Tell Us About Your Primary Care Physician

If yes, please tell us about them:

Let us know about the physician that order the procedure you are preregistering for:

If you are celebrating the birth of your baby with us, we are so happy that you've chosen CHRISTUS Health to share this monumental moment.

Do you already have a pediatrician selected for your precious newborn child? Tell us more about them:

Terms and Conditions

Users are advised that the information submitted through this form may be transmitted over unsecured email and releases CHRISTUS Health and its Associates, agents, and subcontractors from all responsibility or liability for any claims or damages arising from the content of the Email Form or the transmission thereof. By selecting the "I agree to Terms and Conditions" checkbox user acknowledges these terms and conditions and consents to transmission of the form.

MYCHRISTUS

On Demand Care
Pre-register for your procedure with your MyCHRISTUS Account
Login to MyCHRISTUS