Get Patricia Worthey

This guide offers a clear and supportive walkthrough for users looking to complete the Patricia Worthey online form for outpatient services. By following these instructions, you can efficiently provide the necessary information and facilitate a smooth intake process.

Follow the steps to complete your form accurately

1. Click the ‘Get Form’ button to access the Patricia Worthey form and open it in the document editor.
2. Begin by filling in your address details, including street, city, state, and zip code. Ensure all contact numbers—cell, home, and work—are accurate.
3. Provide your email address, and briefly explain your reason for seeking treatment at this time in the designated space.
4. Indicate how you were referred to Dr. Worthey, and decide whether to use your insurance benefits by marking 'yes' or 'no' and initialing your choice.
5. For insurance purposes, enter the primary insurance information including the subscriber's name, insurance ID number, group number, and the insurance company along with the date of birth.
6. If applicable, fill out the secondary insurance information in the same manner as the primary insurance.
7. If completing the form for a couple, include the name of your partner (if applicable) and their contact details, including occupation and place of employment.
8. Designate an emergency contact person and include their phone number.
9. Sign and date the form to authorize release of necessary medical or insurance information.
10. Review all the filled-out details for accuracy before saving changes, and then download, print, or share the completed form as needed.

Complete the Patricia Worthey form online today to take the next step in your therapeutic journey.