Get New Patient History Form - Abilene Endocrinology

Filling out the New Patient History Form is an essential step in receiving appropriate care at Abilene Endocrinology. This online guide provides a step-by-step approach to help you complete the form accurately and efficiently, ensuring that your health information is conveyed properly.

Follow the steps to effectively complete your form.

1. Press the ‘Get Form’ button to acquire the New Patient History Form and open it in your preferred editing application.
2. Begin by entering your personal information at the top of the form, including your name, date of birth, today's date, and reason for your visit.
3. Specify the date of your visit and provide the details of who referred you to the clinic and your primary care provider.
4. Fill out the sections regarding your past medical history. List any current and past medical diagnoses along with approximate dates.
5. Document any previous hospitalizations along with their reasons, dates, facilities, and descriptions.
6. Record any past operations or procedures in the specified section, along with relevant dates, facilities, and descriptions.
7. Indicate any medication allergies, detailing the specific medications and the reactions you experienced.
8. Complete the immunization section by noting the types of vaccines received and their approximate dates.
9. Fill in your current medication history, listing all prescription medications, over-the-counter medications, and supplements, along with their doses and frequency.
10. Answer the habits section by providing information about your smoking, alcohol consumption, and physical activity.
11. Fill in the social history section as comfortable — indicating your relationship status, who you live with, and your occupation.
12. Complete the menstrual and menopausal history, answering relevant questions based on your experience.
13. Document your fertility and pregnancy history, detailing pregnancies, complications, and outcomes.
14. Provide information regarding your family history, specifying any relevant diagnoses within your family.
15. Review the symptom review section and circle any symptoms that apply to you. Fill in the description fields as needed.
16. Use the final space for any additional comments or information that you feel is important.
17. Once all sections are completed, ensure to save the changes, and consider downloading, printing, or sharing the completed form as needed before your visit.

Complete your New Patient History Form online today to prepare for your appointment.