Get Patient Introduction Form - Perfect Patients

Filling out the Patient Introduction Form accurately is essential for ensuring you receive the appropriate care at Handly Chiropractic Clinic. This guide provides clear, step-by-step instructions to help you complete the form online with ease.

Follow the steps to successfully complete the Patient Introduction Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated fields. Include your first and last name clearly as it will be used for your appointment records.
3. Provide your date of birth. Enter this information accurately to help with your identification and care.
4. Fill in your contact information, including home and cell phone numbers, and email address. Ensure these are up to date so the clinic can reach you as needed.
5. Indicate your current address, ensuring to include the street name, city, state, and zip code.
6. Specify your occupation and any relevant insurance information. If you plan to use insurance, mention the provider's name.
7. Complete the health history section by stating your primary care physician's name or indicating if you do not have one. Remember to include any chronic health problems.
8. List any medications you are currently taking and their purposes. This information is critical for your overall care.
9. Answer questions regarding past injuries, surgeries, or any health-related issues that may impact your treatment.
10. Provide information on lifestyle factors such as smoking, exercise, and life stresses, which could affect your health.
11. After completing all sections, review the form to ensure all questions are answered, then save your changes. You can download, print, or share the form as needed.

Start filling out your Patient Introduction Form online today to ensure a smooth and efficient experience at Handly Chiropractic Clinic.