Get Columbia Doctors New Patient Intake Form 2019-2025

Filling out the Columbia Doctors New Patient Intake Form online is a straightforward process that allows you to provide important information for your initial visit. This guide will walk you through each section of the form, ensuring you understand what is required as you complete it.

Follow the steps to effectively complete the form online.

1. Press the ‘Get Form’ button to acquire the Columbia Doctors New Patient Intake Form and open it in your selected editor.
2. Begin with the Patient Information section. Fill in your last name, first name, date of birth, gender, home address, home phone, and email address. Ensure that all fields are completed accurately to avoid any issues.
3. Next, provide information regarding your guarantor or parent if applicable. Include their name, address, phone number, date of birth, city and state, and relationship to you.
4. In the Emergency Contact section, provide details of a person who can be contacted in case of an emergency, including their name, phone number, and relationship to you.
5. Complete the Insurance Information section by entering your insurance company name, address, plan/ID number, subscriber details, and the relationship to you. If available, be sure to attach a copy of your insurance card when submitting the form.
6. Fill in your Employment Information with details about your employer, occupation, and work-related contact numbers. This information can help in coordinating care and billing.
7. If you wish to consent to receive text messages regarding your healthcare services, indicate this in the Text Messaging Agreement section. You may also choose to opt out.
8. In the myColumbiaDoctors Patient Portal Sign Up section, you can express interest in receiving an invitation to join the patient portal. Indicate your preference by checking the relevant box.
9. Provide health care provider information, including your primary care doctor and other specialists. Fill in the preferred pharmacy and its contact information.
10. Lastly, complete the demographic information regarding your ethnicity, race, and preferred language if comfortable, then review the financial obligation and privacy practices sections. Ensure you read and understand these policies.
11. Sign and date the form where indicated. Once completed, you can save any changes, print a copy for your records, or share it as required.

Complete your form online today to ensure a smooth visit to Columbia Doctors.