GMH Online Pre-Registration Form
117 Hospital Drive
Petersburg, WV 26847

Use this form to pre-register for your test, procedure, surgery, or delivery.

If you have services scheduled at Grant Memorial Hospital (GMH), please fill out the following form in it’s entirety. If you have any questions about the online pre-registration process or would like to pre-register by telephone, please call GMH Pre-Registration Department at (304) 257-1026 x2250.

PLEASE NOTE: Online pre-registrations are checked Monday – Friday from 7:30am – 8:00pm. Please allow at least one business day before your appointment for your pre-registration form to be processed. If there is less than one business day before your appointment, please register by calling the pre-registration department at (304) 257-1026 x2250.

Before you begin the pre-registration form, you are encouraged to review GMH’s “Notice of Privacy Practices.” To review that information, please click here.

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The guarantor is the person who is guaranteeing payment (usually the same as the patient if the patient is over age 18).
*If your service is not listed, please contact pre-registration at (304) 257-1026 x2250.