Get Ak Chena Health Ob/gyn Intake Form 2011

The AK Chena Health OB/GYN Intake Form is essential for new patients to provide their health information and facilitate care. This guide offers step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the patient information section. Fill in your last name, first name, and middle initial as indicated. Ensure all entries are accurate.
3. Provide your mailing address, including the city, state, and zip code. It's important to keep this information current for effective communication.
4. Enter your home phone, cell phone, and work phone numbers. Indicate if it's okay to leave a message on your home, cell, or work phone.
5. Fill out your date of birth and email address. Your email will be used for communication regarding your healthcare.
6. Complete your Social Security Number, primary care provider details, race, ethnicity, and marital status by selecting the appropriate options provided.
7. Specify your preferred pharmacy and employee status by choosing the relevant options.
8. Provide information for your emergency contact, including their name, relationship to you, address, and daytime phone number.
9. For insurance information, list your primary and secondary insurance details, including the subscriber's name, date of birth, policy ID, and group number.
10. Review your entries for accuracy. Make corrections if necessary to ensure all information is correct and complete.
11. Once you have filled out the entire form, save your changes. You may choose to download, print, or share the form as needed.

Begin completing your AK Chena Health OB/GYN Intake Form online today!