Get New Patient Forms - Highland Medical

Completing your new patient forms in advance can significantly enhance your registration experience at Highland Medical. This guide provides a clear, step-by-step approach to filling out the necessary fields online, ensuring that your information is accurate and complete.

Follow the steps to successfully fill out the new patient forms.

1. Press the ‘Get Form’ button to access the new patient forms and open them in your designated editor.
2. Begin by filling out the patient information section. Include your last name, first name, middle initial, marital status, contact details, date of birth, race, ethnicity, preferred language, occupation, and employer information. Make sure to double-check each piece of information for accuracy.
3. Proceed to the emergency contact section. Enter the name of your emergency contact, their relationship to you, and their phone number. It’s helpful to provide multiple contact numbers if available.
4. In the insurance information section, provide the cardholder’s name, their date of birth, and address. Include your primary and secondary insurance details along with their policy or ID numbers. Indicate if your visit is related to a work-related injury by circling the appropriate response.
5. If applicable, fill out the referring physician information. Include the physician's name along with their contact details.
6. For the assignment of benefits section, review the statement carefully. If you agree, provide your signature and the date. Include your name and date of birth as well.
7. Sign the release of information section to authorize Highland Medical to share necessary medical information for insurance processing. Be sure to date your signature.
8. Complete the guarantee of payment section by signing and dating it, confirming your understanding of the financial responsibilities.
9. Enter your preferred contact methods for patient communications, including your phone numbers and whether you permit confidential messages to be left.
10. Fill out the medical history section. List any medical illnesses and operations you have had, as well as your current medications. Include any known drug allergies.
11. For records release authorization, specify whom you are authorizing to release your medical records and complete the relevant information.
12. Finally, review all completed sections for accuracy, then save your changes. You may download, print, or share your filled-out form as needed.

Begin filling out your new patient forms online today for a streamlined experience at Highland Medical.