Get New Patient Form - Sites@duke - Sites Duke

Filling out the New Patient Form at Sites@Duke is an essential step for your healthcare journey. This guide will provide you with clear instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the New Patient Form and open it in your preferred document editor.
2. Begin by entering your personal information at the top of the form. This includes your name, date, date of birth, age, and medical record number (MRN). Ensure that all the fields are filled out accurately.
3. Indicate the primary reason for your visit by circling one of the options provided, such as urinary incontinence or bowel incontinence. If your reason is not listed, specify it in the 'Other' field.
4. Answer the allergy question by selecting 'No' or 'Yes' and providing explanations where necessary. Make sure to list any medications you are currently taking, along with their dosages and the conditions they treat.
5. Provide the name and city of your pharmacy to ensure that prescriptions can be filled accurately.
6. In the medical history section, circle any medical conditions that apply to you. Take your time to ensure you include all relevant health issues.
7. Complete the surgical history section by listing any previous surgeries, including details about the procedure, year, and the reason for the surgery.
8. Address the family history questions by checking applicable health conditions for your blood relatives and noting their relationship to you.
9. Under social history, circle the appropriate responses regarding your lifestyle habits. Provide explanations for any 'Yes' answers when prompted.
10. Fill out the obstetric and gynecologic history sections, and include any relevant details about your menstrual cycle and past Paps.
11. Complete the health maintenance section with dates for your last medical tests and immunizations.
12. Finally, review the review of symptoms section carefully. Circle any symptoms that you are currently experiencing, and write down any other symptoms in the provided space.
13. Once all sections of the form are filled out, save your changes. You can then download, print, or share the completed form as needed.

Start completing your New Patient Form online today to ensure a smooth appointment experience.