Get Georgetown Physicians

Filling out the Georgetown Physicians form is an important step in accessing your healthcare services. This guide will provide you with a clear, step-by-step approach to completing the registration accurately and efficiently.

Follow the steps to complete the Georgetown Physicians form.

1. Press the ‘Get Form’ button to obtain the registration form and open it in a digital editor.
2. Begin filling out the personal information section, including your full name (last, first, middle), date of birth, address, age, and medical record number.
3. Next, provide your contact details including your sex, race, phone number, and social security number. There is also a section for marital status.
4. Fill in your employment information by entering the name of your employer, their address, and your occupation along with the phone number.
5. Identify an emergency contact by entering their name, relationship to you, address, and phone number.
6. Provide your primary care physician's details, including their name, address, and phone number.
7. In the guarantor section, list the name and address of the person responsible for billing, their relationship to you, and their contact number.
8. Complete the insurance section by filling in the primary and secondary carrier details, including addresses, policy numbers, and group numbers.
9. If applicable, fill out the worker's compensation section, providing information on your employer, the date of injury, case worker, and insurance carrier.
10. Review all the information filled out for accuracy and completeness. Once confirmed, you can save changes, download, print, or share the completed form as required.

Complete your Georgetown Physicians registration online now for a smoother healthcare experience.