Follow the steps to successfully complete your new patient packet.

1. Click ‘Get Form’ button to access the New Patient Packet and open it in the editor to begin filling it out.
2. In the 'Patient Information' section, fill in your account number, today's date, primary care physician details, and your full name, ensuring that you include your last name, first name, and middle initial appropriately.
3. Complete your address by entering the street address, city, state, and zip code. Include your home and cell phone numbers as well as your email address for communication purposes.
4. Indicate your primary language spoken and check if you require translation or communication assistance.
5. Provide your age, date of birth, social security number, height, weight, gender, and marital status by selecting the appropriate options.
6. Select your race and ethnicity from the provided options, circling one for each category.
7. In the 'Emergency Contact' section, include the name and phone number of an individual to notify in case of emergency.
8. Fill out your current employer information including the employer’s name, phone number, and address.
9. Provide information regarding the area to be treated, the onset of the problem, and a detailed description of your condition.
10. If applicable, answer questions regarding conditions related to employment or automobile accidents, filling in relevant dates and details.
11. Complete the 'Medical History Questionnaire' section, listing any allergies, current medications, and any significant health conditions you may have.
12. Sign the 'Consent for Treatment' section, acknowledging your understanding of the risks associated with your treatment.
13. Review the financial agreement and privacy notices, sign as needed, and finalize your form.
14. Once completed, save any changes made to the form. You can then download, print, or share the completed form as needed.

Take the first step towards your appointment by completing your New Patient Packet online today.