Get New Patient Packet - Greater Mobile Urgent Care

Filling out the New Patient Packet for Greater Mobile Urgent Care online is an important step toward receiving medical care. This guide will walk you through each section of the form to ensure that you provide all necessary information accurately and efficiently.

Follow the steps to complete your New Patient Packet online.

1. Click ‘Get Form’ button to access the New Patient Packet and open it in the designated editor.
2. Begin by filling out the patient label section, which includes your name, date of birth, and contact information. Ensure that all details are accurate for future reference.
3. In the 'Reason for Visit' section, describe any symptoms you are experiencing in the provided space. This information helps healthcare providers understand your needs better.
4. Provide your weight, height, and age. Select your gender from the indicated options.
5. Indicate whether there is a possibility of pregnancy. Answer 'Yes' or 'No' as applicable, especially if you are within the specified age range and presenting certain symptoms.
6. Fill in your primary care doctor's name and any allergies to medications in the relevant sections.
7. Provide a location or phone number for your preferred pharmacy, facilitating prescription calls if necessary.
8. Check any relevant health conditions from the provided list and explain any 'yes' or 'other' responses as needed.
9. List any past surgical history and current medications in the appropriate sections.
10. Complete your personal information, including mailing address, phone numbers, and email. Indicate whether you wish to be added to an email list.
11. Fill in the 'Responsible Party for Patient' section if applicable, providing their details as necessary.
12. Complete the insurance information sections, detailing primary and secondary insurance policies, cardholder information, and relevant identification numbers.
13. Read the Financial Obligation, HIPAA Privacy Notice, and Injection/Testing Consent sections carefully. Sign and date to confirm your understanding and agreement.
14. After verifying all information for accuracy, save changes to your completed form. You may then download, print, or share the document as needed.

Complete your New Patient Packet online now to ensure timely and effective care.