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Radiation Oncology Registration Forms

We are glad you chose Orange Regional Medical Center to receive your care. We will do everything we can to provide you with excellent service and ensure your health care needs are met.

Pre-registering for your treatment shortens the admissions process and saves you time. In order to pre-register successfully, you must have a scheduled appointment. If you do not have an appointment and would like to schedule one, please call 845-695-5999.

Please select the links below to access the forms necessary to pre-register. Print and complete the forms and bring with you the day of your scheduled appointment.

Radiation Oncology Registration Form

Patient Profile

Authorization for the Release of Information (Release)

Authorization for the Release of Information (Receive)

Orange Regional Medical Center Financial Policy

Physician Professional Financial Policy

Orange Regional Medical Center
707 East Main Street
Middletown, NY 10940

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Orange Regional Medical Pavilion
75 Crystal Run Road
Middletown, NY 10940

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Joint Commission National Quality Approved
A member of the Greater Hudson Valley Health System