Facility pre-registration

This is for the pre-registration of non-emergent patients only. Please submit this pre-registration Form at least 48 hours in advance of your hospital check-in to ensure timely process.

If you choose to utilize our pre-registration form, understand that you do so at your own choice and risk. Any information you submit via the pre-registration form is confidential and is only shared with third parties as outlined in our Privacy Pledge.

Pre-registration disclaimer

If you choose to electronically submit a completed pre-registration form or any other information to West Boca Medical Center through this website, you agree that you do so at your own choice and risk, and that you assume all responsibility for any liability arising from such electronic submission and from any errors or omissions in the data you provide. You agree to release and hold West Boca Medical Center and its affiliates (including its directors, officers, employees, shareholders, agents and representatives) harmless from any and all liability or cause of action arising from the interception, access or use by a third party of any information submitted electronically by you through this website and from any errors or omissions in the data you provide. Additionally, the provision of any information to West Boca Medical Center by you through this website, including a completed pre-registration Form, does not create or constitute any relationship between you and West Boca Medical Center, its affiliates, or any of the physicians on its staff, to which any privilege may attach.

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