Pre-admission Form

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Thank you for choosing Pacifica Salud for your health services.

You will be filling out a form to begin the pre-admission process for outpatient procedures, maternity, and hospitalization.

Please fill out the following information and we will contact you within 24/48 hours to continue with the admission process and scheduling your health service.

If you need more information, you can call 204-8171. Please note that until we contact you, the pre-admission process has not been completed.

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