• Baylor Scott & White Medical Center Frisco
    5601 Warren Parkway, Frisco, TX 75034

    Radiology Registration Form

    Completion of this form allows us to register you & file with your insurance. 

    NOTE: * Denotes Required Field.

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  • Emergency Contact: 

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  • Insurance Provider Information:

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  • Secondary Insurance Provider Information (if applicable):

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  •  To expedite your check-in process, please have your Current Insurance Card and Picture ID available.

    The document(s) accompanying the registration form contains(s) confidential information belonging to the author that is legally privileged.   The information is intended only for the individual or entity named above.  If you are not the tntended recipient, you are herby notifed that any disclosure, copying, distribution, or taking of any action in release of the contents of this information is strictly prohibited. If you have received this registration form in error, please notify us by telephone immediately to arrange for the return of the original documents to Baylor Medical Center at Frisco.

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