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How to fill out the Shriners Application online
The Shriners Application for Treatment is a crucial document for parents or guardians seeking medical services for their child at Shriners Hospitals for Children. This guide provides a clear, step-by-step approach to assist you in filling out the application accurately and efficiently.
Follow the steps to successfully complete the Shriners Application online.
- Press the ‘Get Form’ button to access the Shriners Application and open it in your preferred online editor.
- Carefully enter the required information about the child, including their name, date of birth, and social security number.
- Specify who the child lives with and provide the primary language spoken at home.
- Fill in the child's home address, including country, state, county, city, and zip code.
- Indicate the child's gender and provide the names of both parents or guardians, including their phone numbers and alternate contact numbers.
- Complete the marital status section for the parents or guardians and, if applicable, fill out the legal guardian information.
- Provide details about the referring physician and any previous treatments or surgeries the child has had.
- If applicable, include insurance information, such as the primary subscriber name and health plan details.
- Outline the child's medical problem or diagnosis and state the reason for seeking treatment.
- Sign and date the Conditions for Acceptance section, ensuring it is witnessed.
- Prepare and upload any required documentation, such as the child's birth certificate and immunization records, alongside the completed application.
- After reviewing all the information for accuracy, save changes, and then choose to download, print or share the application as needed.
Complete your Shriners Application online today to ensure your child receives the necessary medical care.
Shriners wear a fez as a symbol of their affiliation and commitment to serve. The fez represents a rich tradition and highlights the uniqueness of the organization. It also serves to foster camaraderie among members during events and ceremonies. When you begin your Shriners Application journey, you embrace not just a membership, but also the values and traditions that the fez embodies.
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