Get New Patient Intake Form 2013 03 26 - Utmb.edu

The New Patient Intake Form is a crucial document that helps healthcare providers gather essential information about new patients. This guide will provide clear, step-by-step instructions on how to complete the form online effectively.

Follow the steps to successfully fill out the form online.

1. Press the ‘Get Form’ button to access and open the form in the digital editor.
2. Begin by entering the name of your primary care doctor in the designated field. Provide as much detail as possible, including their first and last name.
3. Next, input the address of your primary care doctor, making sure to include street, city, state, and zip code for accurate correspondence.
4. Enter the phone number of your primary care doctor. Ensure the number is correct to facilitate communication.
5. If applicable, fill in the name and address of the doctor who referred you to this office. Include their phone number for further contact.
6. In the section regarding medication allergies, indicate if you have any allergies by selecting ‘Yes’ or ‘No.’ If yes, specify the medication and type of reaction you experience.
7. List any current medications you are taking, including the name, dosage, duration of usage, and reason for taking each. This information is crucial for your healthcare team.
8. Provide details about any previous or existing medical conditions by checking the relevant boxes next to conditions like diabetes, high blood pressure, heart attack, etc.
9. Document any surgeries you have had by indicating whether you have never had surgery and, if applicable, listing details such as the surgery date, surgeon, and reason.
10. Complete the personal questions regarding smoking, drinking, and family medical history, ensuring all information is accurate and complete.
11. Finally, review all the information you have entered, then save the changes. You may print, download, or share the form as needed.

Complete your documents online today for a smoother healthcare experience.