CHILTON HOSPITAL
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Pre-registration forms at Chilton Hospital

General Admission
If you expect to be admitted or have a procedure done at Chilton Hospital, you can pre-register by calling our Call Center prior to your visit to the hospital. On the day of your admission or procedure, bring any other important information or documents to the Chilton Hospital Access Center when you register.

Call Center Number: 1-888-CHILTON, choose option 5

  • You can use this Personal Medication List to keep track of your health information.
    (fill in all your current health information)

Expecting Mothers
For mothers delivering at Chilton, you can print and complete the pre-admission forms below and mail them to the Chilton Hospital Access Center. Approximately 6 weeks prior to your due date, come in to the Access Center to finish your pre-registration. Remember to bring any other important information or documents with you.

Form Instructions:
Complete the form within your browser and then print. Or, print the form then complete in ink. 

  • Maternity Pre-Admission Form (PDF format) (only if you expect to deliver your baby at Chilton)
     
  • Newborn Registration Form (PDF format) (only if you expect your baby to be born at Chilton)
     
  • Mail forms to:
    Chilton Hospital, Attn: Access Center
    97 West Parkway
    Pompton Plains, NJ 07444

Access Center/Surgical Waiting Area Hours:
Monday through Friday:  4:45 a.m. - 8 p.m.
Saturday:  8 a.m. - 5:30 p.m.

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© 2013 Chilton Hospital, 97 West Parkway, Pompton Plains, New Jersey 1-973-831-5000