Get Registration And Initial History Forms - Physical Medicine ...

Filling out the Registration And Initial History Forms online for the Physical Medicine & Rehabilitation Clinic of St. Louis is a straightforward process. This guide aims to provide you with clear, step-by-step instructions to ensure that all required information is accurately completed.

Follow the steps to successfully complete your registration forms.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the Patient Information section, where you will fill in your last name, first name, social security number, sex, middle initial, date of birth, marital status, address, email, and phone numbers. Ensure you provide accurate information to avoid any issues during your appointment.
3. Next, fill out the Spouse/Parent/Guardian Information section. If applicable, provide the name, relationship to patient, date of birth, and contact details of your spouse, parent, or legal guardian.
4. Proceed to the Insurance Information section. Here, you must enter the primary and secondary insurance details, including the insurance company name, policy number, group number, and the insured person's relationship to you.
5. Complete the Patient History Form, starting with your chief complaint and a description of your present illness. Answer the questions regarding pain severity and past treatments.
6. List any allergies and medications you are currently taking. Be thorough and include over-the-counter medications if necessary.
7. Fill out your past medical history clearly, indicating any previous conditions or surgeries. Include the dates of diagnosis for accuracy.
8. After completing all sections, review the document to ensure no fields are left blank and all information is accurate.
9. Once satisfied with your form, save any changes made. You may then download, print, or share the completed form as necessary.

Start filling out your forms online today to ensure a smooth and efficient appointment.