Online Pre-Registration Form
5301 East Grant Road
Tucson, Arizona 85712
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Pre-register for your test, procedure, surgery or delivery.

If you have services scheduled at TMC, please fill out the following form in its entirety. If you have questions about the online pre-registration process or would like to pre-register by telephone, please call TMC Pre-Registration Department at (520) 324-4734.

Please Note: Online Pre-registrations are checked Monday-Friday, 7:00 a.m. to 7:00 p.m. Please allow at least two full business days before your appointment for your pre-registration form to be processed. If there are less than two full business days before your appointment, please pre-register by calling the Pre-Registration Department at (520) 324-4734.

Before you begin the pre-registration form, you are encouraged to review TMC HealthCare's "Notice of Privacy Practices." To review that information, please click here.

Begin Pre-Registration Form
Answer the following four questions to help us simplify this online form for you.

The guarantor is the person who is guaranteeing payment (usually the same as the patient if the patient is over age 18). Is the patient the guarantor? Yes No

Do you carry insurance? Yes Self Pay, No Insurance

Do you have secondary insurance? Yes No

Are you insured by Medicare or a Seniors' Plan? Yes No