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Home > Short-Term Rehab > Pre-Registration > Pre-Reg Form

300 Shelby Station Dr • Louisville, Kentucky • 40245 • 502.254.0009

Pre-Registration Contact

Please fill out this form and submit it to us so that we can contact you
about reserving your private room at Oaklawn.

*Name:
Address:
*E-Mail:
*Daytime Phone:
Evening Phone:
Best time to call:
*Hospital or Surgical Facility:
*Type of surgery:
*Primary care physician:
Surgeon:
*Date of surgery:
*Date of arrival at Oaklawn:
Insurer Name:
Insurance Number:
Message or other information:

PLEASE NOTE: Submission of this form initiates, but does not complete, the pre-registration process. We will call you to schedule a lunch, tour and meeting to complete the pre-registration process in order to guarantee your private room.

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