Get Cary Orthopaedics & Spine Specialists New Injury/issue Form 2019-2025

Filling out the Cary Orthopaedics & Spine Specialists New Injury/Issue Form online is a straightforward process that helps ensure you receive timely and appropriate care. This guide provides comprehensive instructions on each section of the form, allowing users to complete it efficiently and accurately.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to initiate the process and open the form for completion.
2. Begin by entering your name and chart number at the top of the form. Ensure accuracy as this information is crucial for your medical records.
3. Provide your address, including city, state, and zip code. This will help the practice contact you if necessary.
4. Fill in your phone numbers for home, cell, and work. Providing multiple contact options is helpful for appointment reminders.
5. Enter your email address to receive correspondence regarding your appointment and treatment updates.
6. Complete the section on date of birth, employer, race, ethnicity, and language. This information may assist in providing tailored care.
7. List the name and phone number of an emergency contact, along with your primary care doctor and pharmacy details.
8. Indicate whether you would like to receive appointment reminders via your preferred method: text, home phone, cell phone, or email.
9. In the body part section, specify the location of discomfort, indicating right, left, or bilateral. Also, describe the issue briefly.
10. Assess your current pain level on a scale of 1-10 and provide the approximate date when the issue began.
11. Answer whether the problem is due to an injury. If yes, specify the location and what you were doing at the time of the injury.
12. Indicate if you will be filing through Workers Compensation, auto insurance, or liability insurance. Provide further details if applicable.
13. Complete the consent section, authorizing the physician to release information to your insurance company and agreeing to pay for any charges not covered by insurance.
14. Finally, sign and date the form, confirming that you consent to medical care and treatment.
15. Once you have filled out all sections, save the changes. You can download, print, or share the form as needed.

Get started on filling out the Cary Orthopaedics & Spine Specialists New Injury/Issue Form online today.