Get Hand To Shoulder Center Of Wisconsin Chief Complaint Form

This guide provides clear and detailed instructions on how to effectively fill out the Hand To Shoulder Center Of Wisconsin Chief Complaint Form online. Following these steps will help ensure that your information is accurately captured and submitted.

Follow the steps to complete the Chief Complaint Form online.

1. Press the ‘Get Form’ button to access the Chief Complaint Form and open it in your online editor.
2. Begin by entering your last name, first name, and middle initial. Ensure that you print clearly to avoid any errors.
3. Provide your date of birth and social security number in the designated fields. This information is crucial for identification purposes.
4. Indicate your height and weight. Select your marital status from the provided options.
5. Fill in your employer details along with your occupation and work phone number if applicable.
6. Enter your spouse's name, date of birth, social security number, and place of employment if relevant.
7. Select how you heard about the Hand To Shoulder Center by checking the appropriate box.
8. Indicate the extremity affected by your injury or problem and describe the type of issue you are experiencing.
9. Provide details regarding your hand dominance and any incident type, such as auto accident or work-related injury.
10. Describe how the pain began and the symptoms you are experiencing, indicating any numbness or tingling.
11. Rate your pain level by circling the appropriate number from 0 (no pain) to 10 (most severe).
12. Provide information on what exacerbates or alleviates your symptoms and any treatments you have already undergone.
13. Finally, review your information for accuracy, then save your changes, and proceed to download, print, or share the completed form as needed.

Complete your forms online today to ensure a smooth appointment process.