Get Gbg Maternity Questionnaire Form 2018-2025

The GBG Maternity Questionnaire Form is an essential document for accessing maternity services through Global Benefits Group. This guide provides a step-by-step approach to ensure you fill out the form accurately and efficiently.

Follow the steps to complete the GBG Maternity Questionnaire Form online

1. Click the ‘Get Form’ button to obtain the GBG Maternity Questionnaire Form and open it in your preferred editor to start filling it out.
2. In the 'Patient Information' section, provide your name (Last, First, MI), policy number, GBG ID number, employer's name, date of birth, address, postal code, country, phone number, fax number, and email address. Ensure all information is accurate and complete.
3. Move on to the 'Maternity Information' section. Indicate the anticipated type of delivery by selecting either 'Vaginal' or 'Cesarean Section.' Fill in the expected delivery date and the date of your last menstrual period. If applicable, include details about any history of fertility or infertility treatments, and answer the questions regarding the impact of drugs or procedures on your pregnancy.
4. In the 'Doctor/Facility Information' section, enter your doctor or facility's name, address, postal code, country, phone number, and email address.
5. Complete the 'Authorization' section by entering your name, date, and providing an electronic signature, which serves as a legal equivalency of your handwritten signature.
6. Review all sections to ensure completeness and accuracy. Once finished, save your changes, download a copy of the form, print it out if necessary, or share it through the provided submission methods.

Begin filling out the GBG Maternity Questionnaire Form online today to access the necessary maternity services.