Online Hospital Registration Form

Thank you for using Dignity Health – St. Rose Dominican’s online registration to notify us of your visit. This process should only take 5 to 10 minutes.

To begin the online pre-registration process, you will need:

• All personal contact information (patient, responsible party, and emergency contacts)
• All current Insurance Cards (including Medicare or Medicaid)
• Date of scheduled visit, date of procedure or expected delivery date of your baby
• Type of procedure
• Ordering Physician's First and Last Names

There are multiple steps that need to be completed prior to your admission or procedure:

Step 1: Pre-Registration – Demographic and insurance information is obtained and an initial account is created.

Please note that to effectively process your on-line pre-registration, we must receive it at least 48 hours prior to your scheduled procedure.

After you have submitted your online pre-registration form, please allow at least two (2) days for your information to be available in the registration system at the facility you will be visiting. Our Central Verification Department will contact you by phone to provide a confirmation number and obtain any additional information needed.

If you have less than 48 hours before the time of your procedure you can:

• Pre-register by telephone by calling our Central Verification Office at (702) 616-4666, seven (7) days a week, between the hours of 8 a.m. – 5 p.m., or
• Pre-register in person at the Admitting and Registration Department of the facility where your procedure is scheduled during the following hours of operation:

Hours of Operation

Rose de Lima Campus
Monday - Friday: 5:30 a.m. - 5 p.m.

Siena Campus
Monday - Friday: 7 a.m. - 5 p.m.
Saturday: Saturday: 7 a.m. - 3 p.m.

San Martín Campus
Monday - Friday: 5:30 a.m. - 5 p.m.

Note:  Patient registration areas at each hospital are closed on major holidays. 

Step 2: Pre-Admission Testing (PAT) and Assessment – Pre-admission testing as ordered by physician and/or pre-admission assessment performed by a Pre-Admission Testing Nurse at the facility.

You must speak with a Pre-Admission Testing Nurse who will determine if an onsite assessment is required. Please contact the Pre-Admission Testing Nurse at the facility where your procedure is scheduled:

Rose de Lima Campus
(702) 616-4303

Siena Campus
(702) 616-5030

San Martín Campus
(702) 492-8782

Step 3: Registration – Registration is finalized and required paperwork is signed.

You are required to finalize the registration process and sign any necessary documents in Admitting prior to your procedure whether or not you need to see the Pre-Admission Testing nurse.

Upon arrival to the facility, please check in with admitting prior to your appointment:

• You will be asked to sign the required Condition of Admission/Treatment form. Parents or legal guardians must sign for children under 18.

• You will receive information regarding your rights and responsibilities as a patient.

• Payment is expected at the time of service unless prior arrangements have been made. 

Step 4: Pre-Admission/Procedure Check In – On the day of your procedure, please check in with the Admitting and Registration Department to receive your armband.

Our goal is to make your arrival at our facility as smooth as possible.

If you have questions regarding registration or admitting, please call (702) 616-4560 for the Rose de Lima Campus, (702) 616-5003 for the Siena Campus or (702) 616-4666 for the San Martín Campus.

If you miss your appointment, we reserve the right to delete your submitted information from our records after 30 days.