Get Al Dynamic Pain And Wellness New Patient Packet 2019

Filling out the AL Dynamic Pain And Wellness New Patient Packet online can streamline your appointment process and ensure that all necessary information is submitted accurately. This guide provides clear instructions to help you navigate each section of the form with ease.

Follow the steps to complete your New Patient Packet efficiently.

1. Click ‘Get Form’ button to access the New Patient Packet and open it in your preferred document editor.
2. Begin by providing your personal information. Enter your first and last names, date of birth, cell number, email address, and home address. Ensure that all fields are filled out accurately.
3. Complete the referral information section. Indicate the reason for your referral and provide the details of your referring physician and primary care provider.
4. In the patient personal information section, select your gender (Male, Female, Prefer not to disclose) and marital status. Provide details about your emergency contact and ensure the contact information is accurate.
5. Fill out the primary and secondary insurance details, including subscriber's name, date of birth, policy number, and relationship to the patient.
6. Document your social history, indicating smoking, alcohol use, and drug history as applicable.
7. Detail your medical history by checking any conditions that apply to you. This includes chronic pain, anxiety, diabetes, etc. Be accurate as this will help in your treatment planning.
8. List all current medications you are taking, including prescription and over-the-counter drugs, along with the prescribing doctor.
9. Carefully review the consent forms including the ePrescribe program consent and narcotic use agreement. Sign at the designated spaces confirming your agreement.
10. Once all sections are completed, save the changes made to the document. You can then download, print, or share the form as required.

Take the next step in your health journey by filling out the document online today.