Get New Patient Registration Forms - North Texas Ob-gyn Associates

Filling out the New Patient Registration Forms for North Texas Ob-Gyn Associates online is a straightforward process designed to gather important personal and insurance information. This guide will provide you with step-by-step instructions to ensure a smooth experience.

Follow the steps to complete your registration form online.

1. Click 'Get Form' button to access the New Patient Registration Forms. This will allow you to open the form in your digital editor.
2. Begin by filling in your personal information. Include your full name, age, date of birth, and social security number. Provide your home address, city, state, and zip code, as well as your driver's license number. Ensure you include your contact numbers: home, work, and cell, and your email address.
3. Indicate your marital status by selecting 'Divorced,' 'Married,' 'Single,' or 'Widow.' Fill in your employer details and occupation.
4. Next, provide information about your spouse or guardian, including their name, cell number, employer, and social security number if applicable. Specify your student status and fill in your race and ethnicity.
5. Complete the insurance information section, noting your primary insurance details. Include the insured's name, ID number, group number, employer, and their relationship to you.
6. If applicable, fill in the secondary insurance information similarly. Additionally, provide contact information for a nearest relative, friend, primary care physician, and an emergency contact.
7. Read the patient consent for the disclosure of information. Sign and date the consent area to acknowledge your understanding of the privacy practices and your consent for the necessary sharing of your health information.
8. If you wish to allow family members or friends access to your medical information, list their names and relationships under the 'Patient Preference Regarding Communications of Health Information' section. Confirm how you would like to be contacted regarding health information.
9. Review all the information you have entered to ensure accuracy. Make any necessary changes before finalizing your form.
10. Once completed, save your changes, and you can choose to download, print, or share the form as required.

Complete your New Patient Registration Forms online today for a seamless experience at North Texas Ob-Gyn Associates.