Get Urology New Patient History Form. New Patient History Form

Completing the urology new patient history form is a crucial step in ensuring you receive appropriate care tailored to your medical history and current health status. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to effectively complete the form.

1. Click the ‘Get Form’ button to access the online form and open it for editing.
2. Begin by entering your personal details such as your name, height, birthdate, and age. Make sure to select your gender to provide complete information.
3. Fill in your weight and the name of the person who referred you to the clinic, as well as the name of your primary care physician.
4. Describe the reason for your visit in the provided text box, ensuring to convey any specific concerns or symptoms.
5. List any past medical conditions in the past medical history section, including both current and resolved issues, even if they seem minor.
6. Under the past surgical history section, provide details on any surgeries you have undergone, including the year and reasons for the procedures.
7. Indicate whether you have any allergies to medications, foods, or other substances, and provide explanations if applicable.
8. List your current medications, including dosage and frequency. Make sure to include non-prescription medications such as vitamins.
9. Complete the social history section by answering questions about smoking and drinking habits, as well as marital status and occupation.
10. In the family history section, document any serious medical conditions or cancers that have affected your immediate family members.
11. Assess your pain, if applicable, using the provided pain scale, and describe the nature of your pain.
12. Complete the review of systems section by indicating any symptoms or experiences related to various bodily systems over the last 12 months.
13. Once all sections are completed, check the information for accuracy. You can then save changes, download, print, or share the form as needed.

Complete your urology new patient history form online today for timely and effective medical care.