Get Anatomy In Motion Patient Intake Form - Baimchirobbcomb

Filling out the Anatomy In Motion Patient Intake Form online is a straightforward process designed to collect essential information about your health and the services you may need. This guide will provide you with clear, step-by-step instructions to complete the form efficiently and accurately.

Follow the steps to successfully complete the patient intake form.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Enter today’s date at the top of the form to indicate when you are submitting this information.
3. In the Patient Information section, provide your last name, first name, and middle name. If your legal name differs from the one provided, specify your legal name in the designated field.
4. Indicate your marital status by selecting the appropriate box. Options typically include single, married, divorced, or widow.
5. Fill in your birth date, age, and sex as required in the form.
6. Provide your street address, including the city, state, and ZIP code. If applicable, include your P.O. box.
7. Enter your email address and the name of your employer, along with the employer's phone number.
8. Select how you chose the clinic or who referred you by checking one of the provided boxes.
9. Complete the Billing Information & Reason for Care section by indicating the person responsible for the bill, including their birth date and address if it differs from yours.
10. Provide additional information about the billing person’s relationship to you and their occupation.
11. Indicate if this patient has Medicare and describe your primary interest in care along with primary and secondary areas of concern.
12. In the pain description section, choose from options like aching, throbbing, burning, or tingling.
13. Rate your pain level, and indicate if you have seen other providers for your issue.
14. In case of an emergency, fill out the local friend or relative's name and their relationship to you, alongside their contact details.
15. Affirm that the information provided is accurate by signing the form as either the patient or guardian and including the date.
16. Once you have completed all sections, save your changes, and choose to download, print, or share the form as needed.

Start completing the Anatomy In Motion patient intake form online today to ensure a smooth and efficient experience.