It's a simple process…
Please be forthcoming with your responses. All of your medical information is confidential.
- The time it takes to complete the form is dependent on your personal medical history.
Typically, a person who is healthy and not taking many medications should expect
to spend 15 minutes completing the form. Someone with a more complicated medical
history or list of medications will take longer.
- Upon receipt of your information, a staff member or nurse may call you for further
clarification if necessary.
NOTE – You do not have to fill out a form again if you are returning to the same
medical facility and have already completed this online form prior to a previous
visit. A nurse or staff member will call you to discuss any changes in your medical
history since your last visit.
What will I need?
Before you begin the online admissions form, please make sure that you have the
following information available, as it may be needed to complete your form:
- Prescription medications – names and dosage of each one you
- Over-the-counter medication – names and dosage of each one
you take regularly.
- Vitamin and herbal medications - names and dosage of any
that you take.
- Allergies/Sensitivities you have, and the allergic reaction(s) they cause.
- Previous surgeries, and the year they were performed.
- Medical Insurance – insurance company, policy number, ID
NOTE:Microsoft Internet Explorer Version 11 is not supported and
it may cause the Simple Admit application to misbehave. Simple Admit recommends
using Mozilla Firefox (download a free version of Firefox here), as well as Google
Chrome, Safari (partially supported), or Internet Explorer Versions
9 through Version 10.