Get Dxa Scan Bone Density Test Patient Questionnaire

Filling out the DXA Scan Bone Density Test Patient Questionnaire online is a straightforward process. It allows healthcare providers to gather important information regarding your health status and medical history, ensuring your upcoming bone density test is as effective as possible.

Follow the steps to complete the questionnaire accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by entering the date of your upcoming scan at the top of the form. Next, clearly print your full name.
3. Indicate your sex by selecting either 'Female' or 'Male'. Then, fill out your address details, including city, state, and zip code.
4. Provide your home and work phone numbers, date of birth, and age. You may also enter your Social Security number, but it is optional.
5. Write the name of your referring provider in the designated field.
6. In the insurance information section, enter the details of your primary insurance carrier, including the carrier’s address and information about the policyholder.
7. If you have a secondary insurance carrier, provide that information similarly.
8. Sign the authorization for lifelong insurance, confirming that payment will be made to your healthcare provider.
9. Similarly, sign the authorization to bill Medicare, if applicable.
10. Answer the screening questions about pregnancy, previous scans, weight, height, injuries, family history, and medications, marking 'yes' or 'no' as relevant.
11. Provide details on your medical conditions, medications, and any other relevant health information as prompted in the questionnaire.
12. Complete the final section regarding dietary and lifestyle habits, ensuring all questions are answered fully.
13. Once all fields are filled, review your answers for accuracy. Save changes, and download or print the form for your records or to share as needed.

Begin completing your questionnaire online to prepare for your DXA scan today.