Online preregistration

You can preregister in advance for an appointment at a physician office or for a hospital visit/procedure by using the secure form below. Preregistration for all visits and procedures can be completed up to 24 hours before a scheduled appointment.

If a hospital procedure is scheduled for less than 24 hours away, please preregister with one of our preregistration associates by calling toll-free 1-888-844-0080 and selecting option 3. Our preregistration department is open Monday through Friday from 8 a.m. to 6 p.m.

If a physician office visit is scheduled for less than 24 hours away, please preregister with one of our preregistration associates by calling toll-free 1-866-273-2067. Our preregistration department is open Monday through Friday from 7 a.m. to 4 p.m.

Culpeper Medical Center does not offer online preregistration at this time. Please call the scheduling department at 540-829-4127 for preregistration assistance.

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Emergency Contact Information

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Insurance Information

Part 1: General
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PART II: Liability
PART III: Eligibility
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PART IV: Age

PART IV: Disability

PART IV: ESRD
PART V: ESRD

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Additional Insurance

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General procedure information

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Labor & Delivery Information

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