Chilton Medical Center - ATLANTIC HEALTH SYSTEM
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Pre-registration forms at Chilton Medical Center

General Admission
If you expect to be admitted or have a procedure done at Chilton Medical Center, 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 Medical Center Access Center when you register.

Call Center Number: 973-829-7934

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 Medical Center 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. For more information, please email: Chiltonmaternityreg@atlantichealth.org

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)

    • Birth certificate worksheet
      Please bring your completed birth certificate worksheet with you when you are admitted to our maternity center.
        
    • Mail forms to:
      Chilton Medical Center, Attn: Access Center
      97 West Parkway
      Pompton Plains, NJ 07444

Access Center/Surgical Waiting Area Hours:
Monday through Friday: 6:00am to 7:00pm
Saturday: 7:00am to 3:00pm
Sunday and off hours: please go directly to the Emergency Department

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© 2017 Chilton Medical Center, 97 West Parkway, Pompton Plains, New Jersey 1-973-831-5000