Get Logan University Patient Registration And History 2018-2025

Completing the Logan University Patient Registration and History form online is an essential step in ensuring a smooth experience for your healthcare. This guide provides clear and detailed instructions on how to fill out each section of the form.

Follow the steps to successfully complete your registration.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Enter your personal information in the 'Patient Information' section. This includes your first name, middle initial, last name, date of birth, and gender. Select your gender by marking either the 'Female' or 'Male' checkbox.
3. Fill in your address details. Provide your street address, city, state, and zip code. Ensure that all information is accurate to facilitate communication.
4. In the 'Patient’s Telephone' field, enter your contact number. This will be used for appointment confirmations and important notifications.
5. Complete the insurance information section. Include the name of your insurance company, your insurance ID number, the name of the insured person, their date of birth, and the insurance group number if applicable.
6. In the 'Patient’s History' section, describe your present symptoms or the reason for the imaging study clearly. Include any relevant past surgeries or trauma experienced.
7. If applicable, indicate whether you have a history of cancer by checking the corresponding box and providing details about the type and date of diagnosis.
8. Fill in the details of your referring doctor. Include the doctor’s name, their address, city, state, zip code, telephone, and fax numbers.
9. Review the authorization and assignment to pay physician statement. You may need to sign the form, indicating your consent to allow the doctor to process your medical claims.
10. Finally, save your changes, and choose to download, print, or share the completed form as needed.

Complete your registration today by filling out the Logan University Patient Registration and History form online.