John B. Amos Cancer Center Pre-registration
 

 
Note: This pre-registration form is for NON-Emergency patients only. Please submit this online pre-registration at least 48 hours in advance of your hospital check-in to ensure timely process.

If you choose to utilize our Pre-registration Form, understand that you do so at your own choice and risk. Any information you submit via the Pre-registration Form is confidential and is only shared with third parties as outlined in our Privacy Policy.
Pre-registration Disclaimer
If you elect to electronically submit a completed Pre-registration Form or any other information to Columbus Regional Healthcare System and John B. Amos Cancer Center through this web site, you agree that you do so at your own choice and risk, and that you assume all responsibility for any liability arising from such electronic submission and from any errors or omissions in the data you provide. You agree to release and hold Columbus Regional Healthcare System and John B. Amos Cancer Center and its affiliates (including its directors, officers, employees, shareholders, agents and representatives) harmless from any and all liability or cause of action arising from the interception, access or use by a third party of any information submitted electronically by you through this web site and from any errors or omissions in the data you provide. Additionally, the provision of any information to Columbus Regional Healthcare System and John B. Amos Cancer Center by you through this web site, including a completed Pre-registration Form, does not create or constitute any relationship between you and Columbus Regional Healthcare System and John B. Amos Cancer Center, its affiliates, or any of the physicians on its staff, to which any privilege may attach.