Get New Patient Registration Form (spanish) - Columbiaobgyn

Completing the New Patient Registration Form in Spanish is an essential step for new patients at Columbiaobgyn. This guide will help you navigate through each section of the form effectively to ensure all necessary information is submitted correctly.

Follow the steps to fill out the form and simplify your registration process.

1. Press the ‘Get Form’ button to access the New Patient Registration Form online and open it in an available editor.
2. Begin by filling out the general information section. Enter your last name (Apellido) followed by your first name (Nombre) and middle initial (Inicial 2do nombre). Please ensure your birth date (Fecha de nacimiento) is accurately entered along with your marital status (Estado civil). Indicate your race and ethnicity as requested.
3. Next, provide your primary language. Select your main language from the options listed, specifying if it is English, Spanish, or another language. Fill in your address details including the street, apartment number, city, state, postal code, and country.
4. Enter your preferred telephone numbers. Make sure to include your home phone number and indicate whether your preferred contact is your home or mobile phone. Include your email address for correspondence.
5. In the emergency contact section, provide the name, relationship, and telephone number of a person who can be contacted in case of emergencies.
6. Complete the referral information section by indicating how you learned about Columbiaobgyn and providing any necessary doctor information, if applicable.
7. Fill in your employment information. State your employment status, occupation, and employer details, if applicable.
8. In the pharmacy information section, write the name and contact details of your preferred pharmacy.
9. Provide information regarding the person responsible for the bill (garante) by filling out their name, gender, date of birth, address, and contact information.
10. Finally, complete the insurance information section with details from your primary and secondary insurance providers, including policy and member ID numbers. Certify the accuracy of the information and provide the date of signature at the end.
11. Once all sections are filled out completely, you can save your changes, download, print, or share the completed form as needed.

Take action now and complete your New Patient Registration Form online for a smoother experience at Columbiaobgyn.