St. David's HealthCare

Las Palmas Del Sol Healthcare is the leading healthcare provider for El Paso and the
surrounding region. Our physicians, nurses and staff are committed to keeping our
community healthy and delivering the highest quality patient care available.
As full-service hospitals, we offer comprehensive medical services in nearly
every specialty, so you are never far from the care you need.


Las Palmas Medical Center
 (915) 521-1200
Del Sol Medical Center
 (915) 595-9000
Las Palmas LifeCare Center
 (915) 533-2217
Women & Teen Centers
  Learn More
 Visit our main website at www.StDavids.com

Online Registration

Las Palmas Del Sol HealthCare Registration Form

Choose Your Facility Las Palmas Del Sol HealthCare

Welcome to Las Palmas Del Sol HealthCare online registration. This tool will help you save time by submitting your registration information prior to your visit.

We recognize the confidential nature of the information you are about to submit. For this reason, you are now working in a secure window. Once you have submitted your online registration form, you will receive an email confirming receipt.

Please be aware that once you have started the online registration, you will not be able to save and return later to complete the form. The entire form must be completed in one session. Please have the following items available prior to beginning the online form:

          • Insurance information
          • Social security number
          • Anticipated appointment date
          • Procedure/appointment information

Should you have any questions or difficulty completing this form, please contact us at 915-521-1140 or 915-521-1180, Monday through Friday, 8am–5pm MST.

Thank you for choosing Las Palmas Del Sol HealthCare.

     
 



Appointment Information

Please provide your anticipated appointment or admission date. If you are an expectant mother, please enter your due date.

If you have not already scheduled an appointment, please contact the scheduling office at the facility where your procedure will be performed. If you are scheduled for a surgical procedure which requires preadmissions testing, you will be contacted by a nurse to schedule the necessary testing prior to your date of surgery.

If you encounter any difficulty or have questions about the information required, please contact us at 915-521-1140 or 915-521-1180, Monday through Friday, 8am–5pm MST.

Service Selection  
Obstetrics


Service Information
Procedure Date:
Open the calendar popup.
 

* If your appointment is scheduled in the next 24 hours please register in person upon arrival to your facility
Ordering or Admitting Physician Information
Primary Care Physician:   Referring Physician (if not primary):  

 

Patient Information

Please complete the following demographic information. If you encounter any difficulty or have questions about the information required, please contact us at 915-521-1140 or 915-521-1180, Monday through Friday, 8am–5pm MST.

Patient Details
First Name
  		Last Name
  		Social Security Number
 
Street Address/PO Box
 		 City
 		 State
select
 		 Zip
 		 Country
select
 
Primary Phone
  		Alternate Phone
  		Email
 Date of Birth
 
Gender
select
Marital Status
select
Race
select

 

Emergency Contact Information

Please provide contact information for use in the event of an emergency. If you encounter any difficulty or have questions about the information required, please contact us at 915-521-1140 or 915-521-1180, Monday through Friday, 8am–5pm MST.

Primary Contact (Required)
First Name
 		 Last Name
 
Relationship
select
  		Primary Phone
 		 Email
Street Address/PO Box
 City
 State
select
Zip
 Country
select
 
Secondary Contact (Optional)
First Name
 Last Name
Relationship
select
Primary Phone
 Email
Street Address/PO Box
 City
 State
select
Zip
 Country
select

 

Insurance Information

Please complete the insurance information below. If you encounter any difficulty or have questions about the information required, please contact us at 915-521-1140 or 915-521-1180, Monday through Friday, 8am–5pm MST.

Is this a work-related injury?

Is patient employed?

Patient Insurance Information  (copy patient data )   
First Name
  		Last Name
  		Social Security Number
 
Street Address/PO Box
  		City
  		State
select
 
Zip
  		Country
select
 
Insurance Name
  		Policy No.
  		Group/Plan Number
 
Insurance Authorization No.
 Insured Employer
  		Insured Occupation
Employer Street Address/PO Box
  		Employer City
  		Employer State
select
 
Employer Zip
  		Employer Country
select
  		Employer Phone
 
Secondary Insurance (copy patient data )

 

Form Submission


Once you have submitted your registration form, you will receive an email confirming receipt. Thank you for choosing St. David’s HealthCare. We look forward to providing you with exceptional care.

Please provide an email address for confirmation:
Email confirmation: