Thank you for deciding to register online for your procedure(s) at
Shelby Baptist.Please complete this form at least 3 business days prior to your scheduled procedure
date.After you submit this form, you will receive an email or telephone response
from our registration personnel prior to your admission.
We respect your privacy and will not use your information for any other purposes
than your preregistration with
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Please enter any additional information you believe would be helpful in completing