Get Date: Patient Information - Footdoctorscolorado.com

Filling out the Date: PATIENT INFORMATION form is an essential step to ensure accurate and timely processing of your medical care. This guide provides clear instructions to help users complete the online form efficiently and with confidence.

Follow the steps to complete the Patient Information form online accurately.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the date at the top of the form. This information is vital for record-keeping and confirming your visit.
3. In the PATIENT INFORMATION section, fill in your last name, first name, and middle initial in the designated fields.
4. Provide your Social Security Number (SSN) and date of birth in the respective fields, which are critical for identifying your medical records.
5. Select your ethnicity and race from the options provided. This data may help in understanding your health care needs better.
6. Indicate your age and gender in the appropriate sections.
7. Choose your preferred language from the dropdown options to ensure effective communication during your visits.
8. In the Employment section, select the appropriate option that reflects your employment status and provide your employer's name if applicable.
9. Note your marital status by selecting one of the options provided.
10. Fill in your contact information, including your street address, city, state, zip code, and preferred phone number. Indicate which phone number you would like the office to use for contact.
11. Provide your emergency contact's name, relationship to you, and phone number.
12. Answer the important questions regarding job-related injuries and automobile accidents, informing the office if applicable.
13. Complete the Responsible Party for Account section if applicable, filling in all related fields.
14. Enter your insurance information, including the name of your primary and secondary insurance provider if applicable, plan type, and your policy and group numbers.
15. Fill in the Primary Care Physician section with your physician's name and contact number, and indicate if you want the office to send them documentation.
16. Answer how you heard about the clinic of the visiting practitioners.
17. Proceed through the Initial Podiatric History to describe your symptoms and any previous treatments. Be thorough to enable the best care.
18. Fill out the Family and Personal History sections with accurate information regarding your family's medical history and your lifestyle choices.
19. Complete the Medical History section noting any serious injuries or illnesses and listing any medications you take regularly.
20. Review all entered information for accuracy, then submit the form as required, either by saving, downloading, printing, or sharing it with the clinic.

Complete your Patient Information form online today to facilitate your care.