Get University Of Kansas Medical Center New Patient Intake Form 2013-2025

Filling out the University Of Kansas Medical Center New Patient Intake Form online is a straightforward process. This guide provides a detailed step-by-step approach to help you complete each section of the form accurately and efficiently.

Follow the steps to complete your intake form online.

1. Click the ‘Get Form’ button to access the intake form. This will open the document in an editable format for you to complete.
2. Begin with your personal information at the top of the form. Enter your full name, including your last name, preferred name, and date of birth, followed by your birthplace and sex.
3. Fill in your contact information. Provide your street address, email address, and phone numbers (home, cell, and business). Indicate your marital status by checking the appropriate boxes.
4. Complete the employment section by providing your employer’s name, job title, and business address. This helps the medical center understand your professional background.
5. In the 'Emergency Contact' area, fill in the name and phone number of someone who can be contacted in case of an emergency.
6. The form includes health history sections. Carefully check 'Yes' or 'No' for each health-related question in the various systems (e.g., cardiovascular, respiratory, gastrointestinal).
7. Complete the current symptoms and health behaviors profile by circling the appropriate responses related to your health practices and feelings.
8. As you fill out the physical exam history, be sure to include details on past surgeries and any medications, including supplements you may currently take.
9. Under the family health history section, provide information about the health status of immediate family members, noting any significant illnesses.
10. Once everything is completed, review the form for accuracy. Save your changes, and if needed, download or print the finalized form for your records.

Get started today by completing your University Of Kansas Medical Center New Patient Intake Form online!