Get Canada Calgary Sports Health And Performance Patient Intake Form

Filling out the Canada Calgary Sports Health And Performance Patient Intake Form is an essential step to receive the best care possible. This guide provides clear and comprehensive instructions to help you complete the form efficiently and accurately.

Follow the steps to complete the online patient intake form.

1. Click ‘Get Form’ button to obtain the form and access it in your preferred editor.
2. Begin with the patient details section by clearly entering your first name, middle initial, and last name in the appropriate fields. Make sure to fill in your address, including city, province, home and cell phone numbers, and email address.
3. Indicate your date of birth in the specified format. You can opt out of email updates for appointment reminders by checking the box if you desire.
4. Input your health card number, employer, and current occupation in the respective fields. Provide details regarding your injury, including the date and nature of the injury.
5. Specify the referral source by selecting one of the options listed, or indicate if you are a returning patient.
6. If applicable, provide information about your family physician and their contact number. If the patient is under 18, complete the guardian details section.
7. In the main concern section, describe your primary issue, duration, and any previous treatments received. Include details about factors that may affect your condition.
8. List current medications, previous surgeries, major injuries, and any motor vehicle accidents you have experienced, making sure to include dates where possible.
9. Address lifestyle questions, including smoking habits, hobbies, and any additional information relevant to your health.
10. In the health history section, indicate any past or current medical conditions, marking 'YES' or 'NO' as applicable. Provide detailed information if necessary.
11. Rate your current pain level and indicate past pain status on the provided scales. Use the diagrams to mark areas of pain.
12. Complete the payment section if applicable by providing credit card information for billing purposes and specifying your preferred receipt method.
13. Acknowledge and agree to the cancellation policy, then provide your signature and date, or ensure a guardian signature if the patient is under 18.
14. Finally, review all entries for accuracy before saving your changes. You can download, print, or share the completed form as needed.

Start completing your Canada Calgary Sports Health And Performance Patient Intake Form online today.