Pre-Registration Online Form

Thank you for choosing Gwinnett Medical Center for your health care needs. Please select your registration type then complete the online form to pre-register for your service or procedure. The information you submit here is kept confidential and will become part of your medical record. In order to utilize our online preregistration service, you must preregister at least 24 hours prior to your appointment time.
* Registration Type:
Patient Biographical Information
Responsible Party Information
Next of Kin Information
Primary Insurance
Secondary Insurance
Tertiary Insurance
Medical Information