Get Buffington

This guide provides clear instructions for completing the Buffington Patient Information Form online. Whether you are a first-time user or seeking to update your details, this step-by-step approach will assist you in providing the necessary information accurately.

Follow the steps to fill out the Buffington Patient Information Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This action will allow you to access the necessary sections for completion.
2. Begin by entering the patient’s legal name in the designated field. If there is a preferred name, fill that in the corresponding space as well.
3. Fill in the birth date and Social Security Number in the following fields. Please be cautious to enter these details accurately.
4. Select the appropriate gender and marital status by checking the corresponding box. Additionally, indicate if the patient is a minor if applicable.
5. Provide the mailing and physical addresses including city, state, and zip code. Ensure all details are current to avoid any communication issues.
6. Include home and cell phone numbers, along with the patient's employer and work phone number. These contacts can be crucial for appointment reminders.
7. Enter the name and contact details of the person responsible for the account. Make sure to specify if you authorize contact through email or text for appointment reminders.
8. If applicable, complete the section regarding dental insurance. Enter the primary and secondary insurance information, including employee names and dates of birth.
9. For patients under 18 or students, fill out the parent or guardian's details including their names and phone numbers.
10. Read through the consent sections regarding the release of medical information, payment responsibilities, and acknowledgment of privacy practices. Initial where indicated to show your agreement.
11. Finally, ensure that all information is accurate before signing and dating the form. This confirms your understanding and agreement to the terms outlined.
12. After completing the form, you can choose to save changes, download, print, or share the completed document as needed.

Complete your Buffington Patient Information Form online today for a seamless dental care experience.