Get Ok Integris Health Patient Registration 2012-2025

Completing the OK INTEGRIS Health Patient Registration online is a straightforward process designed to gather essential information for your visit. This guide will walk you through each section of the form to ensure a seamless registration experience.

Follow the steps to complete your patient registration efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the document editor.
2. Fill out the 'Patient Information' section. Begin with your first name, middle initial, and last name. Then, provide your street address, city, state, zip code, and contact numbers, including your email address.
3. Continue by entering your date of birth, marital status, and social security number. Also include your employer’s name and address along with the employer's phone number.
4. Select your sex from the options provided. Please ensure to present your insurance card at each visit.
5. Provide information about your primary physician and an emergency contact including their name, relationship to you, and their phone number.
6. Indicate your race and ethnicity by selecting the appropriate options from the checkboxes. Additionally, specify your preferred language.
7. Fill out the section on 'Guarantor Information' only if the guarantor is different from the patient. Include their first name, last name, address, date of birth, and contact information.
8. Provide your primary insurance information. Include the insurance holder's name, policy number, employer details, and any other required information.
9. If applicable, fill out the secondary insurance section with the necessary details.
10. Indicate how you were referred to the clinic by checking the relevant option.
11. Review the consent for treatment section carefully and sign where indicated. Provide the best phone number to contact you and enter the date.
12. Once you have completed all sections, save your changes. You may also download, print, or share the completed form as needed.

Complete your patient registration online to ensure a smooth and efficient visit.