Your physician has recommended that you have a surgical procedure and has scheduled an appointment for you.

Pre-registration is a two-step process that must be completed before having surgery at Sutter Roseville Medical Center.

Step 1: Completion of the Pre-Registration Form

Please enter your information on the following pages. This form should take 10-15 minutes to complete. You will need your insurance information. 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 will not be sent.

The following information is required in order to proceed with on-line pre-registration:

*Will your surgery occur after Aug 27, 2016 and before Sep 24, 2016?

If you have answered "no", you must pre-register by phone. Please call 916-781-1628.

If you have answered "yes", please proceed to the next page.

To protect and keep your information secure, you must complete this form in one session.

You will need your emergency contact and insurance information available.

Step 2:

A PreSurgical Nurse will contact you to complete a health history so that we can be fully prepared for your surgical procedure. This telephone interview will take 15 to 30 minutes of your time. You may expect a call from the PreSurgical Nurse 2 or 3 days prior to your scheduled procedure. If you have not received a call and completed a health history by the day before your scheduled procedure, you may contact the Presurgery RN at 855-398-1637. You may also call us at these numbers for any questions or concerns about your procedure at any time. A PreSurgical Nurse is available Monday - Friday from 8:00 am to 5:00 pm. If you leave a recorded message, your call will be returned within 24 hours.

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 HIPPA requirements .   You can verify Sutter Roseville Medical Center is collecting your information over a secure site by clicking on the padlock icon padlock icon 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 who have no insurance. Financial assistance is based on income, assets and other factors. Confidentiality of information and individual dignity will be maintained for all who seek this service.

For specific information on our financial assistance program, please call our Financial Assistance Representative at 916-781-1140. Please be aware that we frequently approve financial assistance prior to providing services as well as after services are rendered.