Get New Patient Phone Call Form 2020-2025

Filling out the New Patient Phone Call Form online is a straightforward process that ensures efficient communication for your upcoming appointment. This guide provides clear, step-by-step instructions to help you complete the form accurately and with ease.

Follow the steps to complete your New Patient Phone Call Form online.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Enter the appointment date in the designated field at the top of the form.
3. Fill in the patient’s name, including the first and last name fields.
4. Indicate the appointment time next to the relevant field.
5. Complete the section for the person making the appointment, including their relationship to the patient.
6. Input the patient’s date of birth in the specified format.
7. Select the patient’s gender by marking either male or female.
8. Provide various phone numbers: home, cell, and work, as applicable.
9. Identify the best phone number to reach the patient.
10. Fill in the mailing address in the appropriate fields.
11. Specify who referred you to the office by filling in the blank.
12. Answer whether any siblings are registered at the office.
13. If applicable, describe any special medical needs the patient has.
14. List any medications currently taken by the patient.
15. Indicate whether the patient had dental X-rays in the past year by checking yes or no. If yes, provide the name of the doctor and the date requested.
16. Mention any specific issues or concerns the patient would like to discuss during the visit.
17. Select the insurance provider by marking private pay or Medicaid and fill in the necessary provider details.
18. Indicate how the new patient information was obtained by checking either 'Mailed' or 'Printed from Internet'.
19. Finally, remember to inquire if the patient needs directions to the office.
20. Once all sections are completed, save changes, download, print, or share the completed form as necessary.

Start completing your New Patient Phone Call Form online today for a smooth appointment experience!