Preadmission form for Silver Hill Hospital

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Pre-Admission Form
If you feel you, or someone else you care for, is in a crisis or at risk to themselves or someone else, call 911 immediately.

Please complete the following form. Our Admissions Coordinators are available to help you or someone you love, Monday through Friday from 9 a.m. through 11 p.m., and Saturday and Sunday from 9 a.m. through 9 p.m.

If you want more information about Silver Hill Hospital, please complete the following form or, call 1-866-542-4455.

Name
Address
City
State
ZIP Code
Phone
Email
Reason for Contacting Silver Hill Hospital
Insurance Company
Plan Number
How did you hear about Silver Hill Hospital
If other, please explain here
Who were you referred by

Note: If you do not intend to use insurance to pay for services, our Admissions Coordinators will provide additional information on payment options.

"When I got here, everyone was so friendly and nice. It was amazing how much people wanted to help you." - Rhoda P.