Allina Health preregistration form for Mercy Hospital and Mother Baby Center (Coon Rapids)


We encourage all patients to preregister. This way, your paperwork can be prepared before you arrive and we can expedite your check-in process.

To preregister online simply fill out the form below.

  • Make sure all required fields (*) are filled in.
  • If a required field does not apply to you, type in "NA" or "Not Applicable."
  • Fill in as many fields as possible so we can best prepare your registration.

Bring your completed health care directive. The document gives written instructions about your medical care should a health care crisis occur. Learn about completing a health care directive.

If you have questions or would like to preregister by telephone, call 612-262-5335. If your appointment is less than one full business day away, call to preregister.

Please note: Online preregistrations are entered Monday through Friday, 8 a.m. to 4:30 p.m.

COVID-19 testing:Patients who are having a planned surgical procedure are require to take a COVID-19 test 4-6 days prior to their procedure. If you don't have a test scheduled, contact your provider's office.


Patient information

In order to enroll in MyChart/MyAccount, you must provide an email.

MyChart is the secure way to manager your health care online. View your discharge instructions, access portions of your health records, plus other features. Learn more here....

Emergency contacts

Guarantor information

Insurance information

Primary insurance information

Secondary insurance information

Tertiary / Third insurance information

Medicare information

Accident/injury information

Motor Vehicle type of accident or injury, please provide the following information:

Work type of accident or injury, please provide the following information:

Third party liability or Other type of accident or injury, please provide the following information