Get Docubank Healthcare Directive Registry Enrollment Form

Filling out the DocuBank Healthcare Directive Registry Enrollment Form online is a crucial step in ensuring your directives are accessible when needed. This guide provides you with clear, step-by-step instructions to complete the enrollment process efficiently.

Follow the steps to complete your enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your member information in Section A. Fill in your name, contact information, and email address, ensuring your email is accurate for online account access. If you wish, include details about a trust or attorney, if applicable.
3. Choose your service selection in Section B. Decide whether you want to store a medication list and review the options available.
4. In Section C, select your payment method. Choose between annual or five-year payment plans and fill in the necessary payment details, including credit card information or check options.
5. Complete Section D by adding your emergency contacts. Provide their names, relationship to you, and various contact numbers. This information is optional but beneficial for accessibility.
6. Enter your physician information in Section E. Provide their name and contact number, along with a fax number if you want faxes to be sent to them.
7. For optional card information in Section F, indicate any medical allergies and permanent conditions. Fill in the card note if you want specific health information noted.
8. If you wish to include a medication list, confirm whether it is signed and dated as outlined in Section G.
9. In Section H, read the member statement carefully, then sign and date the form to verify the information provided and agree to the terms before concluding the process.

Complete your DocuBank Healthcare Directive Registry Enrollment Form online now to ensure your future healthcare preferences are documented.