Get Gi - New.doc

Filling out the GI - NEW.doc form online is a straightforward process that ensures your patient information is accurately submitted. This guide provides step-by-step instructions to help you navigate each section confidently.

Follow the steps to complete the form online effectively.

1. Press the ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Begin by providing the patient’s information in the designated fields, including the patient's name and birthdate clearly.
3. Indicate the patient’s gender and marital status by selecting the appropriate options.
4. Include the patient’s address and, if different, the mailing address in the specified sections.
5. Fill in the patient’s contact information, including home, work, and cell numbers, along with the Social Security number.
6. Provide details regarding the patient's employer and occupation.
7. If the patient is a minor, enter the responsible party's details, including their relationship to the patient.
8. Complete the reference section with a name and contact information for a relative or friend living at another address.
9. Fill out the insurance information section, including primary and secondary insurance details, group numbers, subscriber names, and effective dates.
10. Read and agree to the financial agreement, extension of credit, and authorization for treatment by signing where indicated.
11. Answer the questions regarding advance directives, and if applicable, provide signatures and dates.
12. Complete the payments of benefits authorization and any necessary subsequent sections by signing and dating each.
13. Review all entries for accuracy before saving the document, as well as considering options to download or print the completed form.

Complete your GI - NEW.doc form online today for a seamless submission.