Pre-Registration

Pre-registering for your hospital visit will prepare us for your arrival and save you time when you check into the hospital. Please complete this form and fax or email it to the hospital listed below.

Pre-Registration Form

For patients being admitted within the next 48 hours: Please do not fill out this online form. Call the hospital directly during normal business hours to pre-register by phone. If you have a Monday appointment, you cannot pre-register online or by phone after 5 p.m. on Friday. You will be able to register when you come in for your Monday appointment.

Providence Tarzana Medical Center
18321 Clark Street
Tarzana, CA 91356
818-708-5683
Fax: 503-215-0826
ORWebRegister@Providence.org

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