Get Tx Austin Thyroid & Endocrinology New Patient Registration Form 2020-2025

This guide provides you with comprehensive and supportive instructions on how to complete the TX Austin Thyroid & Endocrinology New Patient Registration Form online. By following these steps, you will ensure that all necessary information is accurately submitted to facilitate your new patient registration.

Follow the steps to successfully complete your registration form.

1. Click ‘Get Form’ button to access the TX Austin Thyroid & Endocrinology New Patient Registration Form and open it in your preferred editing tool.
2. Begin by entering your personal information. This includes your last name, first name, and middle name. Fill in your address, city, state, and zip code accurately.
3. Next, input your contact details such as your cell phone number, home phone number, email address, and the date of birth. Be sure to provide your age as well.
4. Indicate your marital status by checking the appropriate box (single, married, divorced, or widowed), and provide your driver's license and social security numbers for identification purposes.
5. Fill out your insurance information, including the name of your insurance provider, as well as your occupation and employer name.
6. List the name of your primary care physician and referring physician, if applicable. Additionally, identify how you heard about Austin Thyroid & Endocrinology by selecting one of the given options.
7. If you have additional contacts for billing or medical information disclosure, complete the corresponding fields and select the appropriate checkboxes based on your consent.
8. Select your preferred method of communication regarding medical conditions, and specify how you wish to receive appointment reminders.
9. Finally, review all your entered information, and once satisfied, save your changes. You can then download, print, or share the completed form.

Complete the TX Austin Thyroid & Endocrinology New Patient Registration Form online to get started with your healthcare journey.