Get Outgrowth Registration Form - Paris Orthotics

The Outgrowth Registration Form is essential for enrolling in the Orthotic Outgrowth Program, which offers discounts on growth-related replacement orthotics. This guide will provide clear, step-by-step instructions to help you fill out the form accurately online.

Follow the steps to complete the Outgrowth Registration Form

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Enter the date at the top of the form in the designated field.
3. Fill in the patient's full name in the space provided on the form.
4. Indicate the patient's sex by selecting either 'Male' or 'Female' in the corresponding checkbox.
5. Provide the patient's birthdate in the specified format (MM/DD/YYYY).
6. Complete the section for the health care professional, entering their full name.
7. Fill in the health care professional's address accurately.
8. Provide the telephone number and fax number of the health care professional as instructed.
9. If applicable, enter the details for the parent or guardian, including their name and address.
10. Select one option from the list provided to indicate whether this is the initial pair, first replacement, or second replacement orthotics.
11. Ensure that the health care professional certifies the patient's qualification for the Orthotic Outgrowth Program by signing in the designated area.
12. After completing the form, make sure to save any changes made. Users can then download, print, or share the form as needed.

Start filling out the Outgrowth Registration Form online today for efficient processing of your growth-related orthotic needs.