Follow the steps to complete the consultation worksheet.

1. Press the ‘Get Form’ button to retrieve the form and open it in your preferred format.
2. Enter the date at the top of the form where indicated.
3. Select your preferred location for the consultation by checking the appropriate box. Include the contact number for the chosen location.
4. Indicate the nature of your visit by selecting one of the options: Routine, Priority, ASAP, or STAT.
5. Fill in the patient's name, address, city, state, and zip code clearly in the designated fields.
6. Provide the patient's Social Security number and date of birth in the specified areas.
7. Input the home or mobile phone number for the patient.
8. Enter the name of the insurance provider along with the type of plan selected (HMO, PPO, POS, or Other).
9. Complete the insurance policy number, member services phone number, and group number as requested.
10. Fill in the referring physician's name, contact number, and fax number.
11. Indicate the office location and provide the contact person's name.
12. For the history & physical section, fill in the date of the first prenatal visit, the number of weeks pregnant at the most recent visit, last menstrual period (LMP), estimated due date (EDD), and blood type.
13. Note the date of the most recent ultrasound and indicate if the patient has been seen or referred to another maternal-fetal medicine specialist.
14. Select the appropriate diagnosis by checking the corresponding box and ensure to fax all relevant labs and obstetrical notes.
15. Choose the requested service by checking the relevant box for the ultrasound consultation or other services.
16. Scheduled appointment time should be recorded in the last section of the form.
17. Once all sections are completed accurately, save changes, and decide whether to download, print, or share the form.

Complete your consultation worksheet online today to ensure a smooth experience at your appointment.