Using our Online Pre-Admission Form

Please enter your information on the following pages. The fields with an asterisk are required and must be completed in order for you to be able to submit the form; if these fields are left blank, your registration won't be sent.

Your Privacy

Sutter Roseville Medical Center assures protection of your personal health information. Our website securely transfers your information to our data systems. You may read about our Privacy Policy and HIPAA requirements (Opens new window) here. You can verify Sutter Roseville Medical Center is collecting your information over a secure site by clicking on the padlock icon located near your browser's address bar to view our certification form.

Financial Assistance

Sutter Roseville Medical Center is a not-for-profit organization, and we recognize that medical bills are sometimes unexpected, and can be unaffordable. Because of this, Sutter Roseville Medical Center has a financial assistance program also known as Charity Care. This program is designed to help patients that have no insurance, or limited insurance coverage, with their bills. Financial Assistance is based on income and other factors. Confidentiality of information and individual dignity will be maintained for all that seek this service.

For specific information on our financial assistance program, please call our Financial Assistance Analyst at (916) 781-1022 for an information packet and application. Please be aware that financial assistance eligibility is usually determined after services are rendered, and hospital deposit requirements have been met.

Please Note

In preparation for welcoming your newborn/child, and in accordance with California Law, a car seat must be obtained before leaving the Sutter Roseville Medical Center facility.

If you are new to the area and want to select a physician, or have additional questions, please provide your contact information in the "Comments" section of this form and someone will contact you.