Get New Patient Forms

Completing the New Patient Forms online is a crucial step in preparing for your visit. This guide will provide you with clear and detailed instructions on how to accurately fill out each section of the forms to ensure a smooth registration process.

Follow the steps to successfully complete your New Patient Forms online

1. Press the ‘Get Form’ button to access the New Patient Forms and open them in your preferred online editor.
2. Begin with the patient's information section, entering the patient’s name, date of birth, social security number, and email address. Ensure that you fill in the address details, including apartment number, city, state, and zip code. Provide the home, cell, and work phone numbers.
3. Indicate the marital status by selecting the appropriate option and specify the sex of the patient. Provide information regarding race and ethnicity by selecting the applicable options.
4. Move on to the insurance information section. Fill in the primary insurance name and contact number, and provide the insured's details, including their date of birth and relationship to the insured. Enter the policy holder number, group number, and co-pay if applicable.
5. Complete the pharmacy information section by entering the pharmacy name and address. Ensure all details are accurate for efficient processing.
6. Fill out the emergency contact section. Provide the name, relationship, phone number, and address of a contact in case of emergencies.
7. Specify the referral source by selecting the appropriate option and providing any additional details if applicable.
8. Review the assignment of benefits and financial agreement. Ensure you understand and agree by signing and dating the section.
9. Complete the office policies and contact permission sections as instructed. Provide your email address and contact information for future communications.
10. Fill out the HIPAA consent form, understanding what you are authorizing Wiseman Family Practice to do with your health information.
11. In the medical history section, accurately provide all relevant information regarding your medical background, family medical history, and any current medications.
12. After completing all sections, review the entire form for accuracy. Once satisfied, save your changes, and choose to download or print the filled form as needed.

Start filling out your New Patient Forms online today to ensure a seamless registration experience.