Get New Patient Information Packet - Guthrie - Guthrie

Welcome to the guide on completing the New Patient Information Packet for Guthrie Weight Loss Center. This form is an essential first step in your appointment process, and this guide will provide clear instructions to ensure you fill it out accurately and efficiently.

Follow the steps to complete the New Patient Information Packet effectively.

1. Press the ‘Get Form’ button to access the New Patient Information Packet and open it for editing.
2. Begin by providing your personal information in the 'Patient Information' section. Fill in your name, date of birth, gender, and address. Ensure all details are correct to avoid any appointment delays.
3. Next, indicate your program of interest, selecting either 'Medical Program' or 'Surgical.' This helps the staff understand the nature of your visit.
4. Complete the contact information, including your home, cell, and work phone numbers, along with your email address. This enables quick communication regarding your appointment.
5. In the 'Marital Status' section, choose the option that applies to you. If your current status does not fit in the given options, select 'Other.'
6. Provide employer details along with your spouse’s employer if applicable.
7. Fill in the 'Emergency Contact' details, ensuring to include their name and relationship to you, and their phone number.
8. Identify your 'Referral Source' by selecting how you learned about the center.
9. In the 'Physician Information' section, include details of your primary care physician or referring physician. Accuracy is key as this can affect your care.
10. Fill in your insurance information, ensuring to provide the policyholder name (if different), insurance company, and corresponding policy numbers.
11. Complete the medical history section. Check all boxes that apply to your health conditions and management methods.
12. In the 'Surgical History' section, list any past surgeries, including the type and approach. Providing this information enables better preparation for your visit.
13. Fill in the family history and social history sections accurately to give a comprehensive overview of your health background.
14. Document any medications and allergies you have under the corresponding sections, ensuring all responses are clear.
15. Complete the review of body systems and significantly provide details of any symptoms you might be experiencing.
16. Finish by filling out the mental health history, obesity history, weight management history, sleep assessment, and exercise history, if applicable.
17. Once all sections are filled out completely, sign and date the form. Ensure all provided information is correct to the best of your knowledge.
18. Finally, save your changes. You can download, print, or share the form as needed. Ensure it is submitted in person or by mail to the Guthrie Weight Loss Center.

Complete your New Patient Information Packet online today to begin your journey towards a healthier lifestyle.