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Surgical Pre-Admission Form

Thank you for choosing Trinity. To assist in making your admission process easier, please complete this form within 48 hours of receiving it. When finished, you may submit it electronically or print and mail it. If you have questions regarding this process, call (309) 779-5235.

What you will need:

• insurance card(s) and information about the subscriber(s)
• contact information for your spouse and/or alternate contact
• information about past surgeries and any medications you are taking
• about 20 minutes to complete this form.

Please click here to open the secure Surgical Pre-Admission Form.