Get East Lake Pediatrics

Filling out the East Lake Pediatrics Patient Update Form online is essential for ensuring that your family's contact information is accurate and up to date. This guide will provide you with clear instructions to help you navigate the form smoothly.

Follow the steps to complete your Patient Update Form

1. Click ‘Get Form’ button to obtain the form and open it in the editing tool.
2. Begin by entering the information for Parent #1, including their name, address, and contact details. Ensure you specify whether the preferred and alternate phone numbers are home or cell by selecting the appropriate checkbox.
3. Indicate if you consent to receive text messages by selecting either 'Y' for yes or 'N' for no. If you agree, please provide the number where you can receive texts and include the work phone number as well.
4. Next, fill in the email address for Parent #1. Make sure it is spelled correctly to avoid any communication issues.
5. Now, repeat the process for Parent #2, entering the same type of information as for Parent #1, including name, address, phone numbers, text message consent, and email.
6. In the next section, enter the names and dates of birth for each patient in your care. Ensure that all names are written clearly and that the correct dates are recorded.
7. Provide the emergency contact person's name along with their home and cell phone numbers to ensure swift communication in case of an emergency.
8. Finally, have the parent or guardian sign the form in the designated area, and include the date of completion. This signature is important for validating the information provided.
9. Once you have filled out all the required fields, save any changes you made. You may also choose to download, print, or share the form as necessary.

Complete your Patient Update Form online today to keep your information current.