Get Ut Hoyal Podiatry Registration Form 2018-2025

Filling out the UT Hoyal Podiatry Registration Form online is an essential step toward receiving quality podiatric care. This guide provides clear instructions to help you complete the registration smoothly and accurately.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to initiate the process and access the registration form in your online document editor.
2. Begin by entering your personal information in the 'Patient Information' section. Fill in the legal name fields as follows: First Name, Middle Name, Last Name, and Preferred Name. Enter your Date of Birth and select your Gender.
3. Indicate your marital status from the options provided. Please ensure your email address is correct, as it will be used to access your medical records online. Enter your Social Security Number, street address, city, state, and zip code.
4. Select your preferred method of appointment confirmation, choosing between phone call, email, or text. Provide your preferred phone number and select the type (cell, home, or work).
5. Complete the sections on race and ethnicity by circling your responses. Be honest and respectful when providing this demographic information.
6. Fill in the 'Responsible Party Information' if the patient is a minor or unable to sign for themselves. Provide the responsible person's name, relationship to the patient, and their contact details.
7. For 'Insurance Information,' complete the primary insurance details. If you have submitted your insurance cards at the front desk, this section does not need to be filled out. Otherwise, list the insurance company name, subscriber's name, birth date, relationship to the subscriber, policy number, and insurance phone number.
8. If applicable, provide secondary insurance information by following the same steps as for primary insurance.
9. In case of an emergency, provide the name, relationship, and contact number of a local friend or relative who can be reached.
10. Review the accuracy of the information provided. At this point, you may digitally sign the form, confirming that the information is true to the best of your knowledge.
11. Once all sections are complete, save your changes. You may download the form for your records, print it out, or share it as necessary.

Complete your registration form online to ensure a smooth and timely appointment at UT Hoyal Podiatry.