Get New Patient Form - Douglas Webb

Completing the New Patient Form is an important step in your journey to receiving care at Douglas Webb's office. This guide will walk you through the necessary sections of the form to ensure that you provide all the required information accurately.

Follow the steps to successfully complete the New Patient Form online.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering your personal information including your last name, first name, middle initial, and birthdate. Make sure to fill in clearly to avoid any errors.
3. Specify your age, sex, and marital status by selecting from the options provided. This information helps the office better understand your demographic context.
4. Indicate your race and ethnicity from the list provided. You may select more than one option if applicable.
5. Input your Social Security number, home phone, mobile/cell phone, and work phone. Also, provide your email address for communication purposes.
6. Fill in your complete street address along with the apartment number, city, state, and zip code to ensure accurate location details.
7. List your family doctor’s name and the date you were last seen along with their contact number.
8. Select your preferred pharmacy and include its location and phone number.
9. Provide the name and contact number of your spouse or parent, and fill out the emergency contact information for someone not living in the same household.
10. Complete the responsible party section by providing the name, relationship to the patient, and their contact information. Include their address and employer details if applicable.
11. Read and authorize the consent for healthcare section. It’s crucial to understand your rights regarding the information shared with your insurance and treatment providers.
12. Complete the medical history section by circling any conditions you have or have had, and listing past surgical procedures.
13. Detail any current medications. Ensure you include vitamins and supplements as well.
14. Fill out the family history and social history sections by circling relevant conditions and detailing substance use if applicable.
15. Complete the allergy section by circling any known allergies and provide details on potential reactions.
16. Specify any chief complaints regarding your foot health and the duration or previous treatments for these complaints.
17. After completing all sections, review the form to ensure all information is correct and clearly written.
18. Once satisfied, save your changes, and download or print the form. You may also share it via your desired method.

Start filling out the New Patient Form online today to prepare for your visit!