Get Cardiovascular Institute Of The South New Patient Packet 2016-2025

Filling out the Cardiovascular Institute of the South New Patient Packet online is a straightforward process designed to streamline your experience. This guide will provide you with detailed instructions for each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to accurately complete the New Patient Packet:

1. Click 'Get Form' button to access the New Patient Packet and open it for editing.
2. Begin with the Patient Information section. Fill in your full name, date of birth, chart number (if applicable), and age. If you are a minor, please complete the Guarantor Information section as well.
3. Provide your Social Security Number and indicate your marital status from the available options (e.g., single, married, divorced). Specify your ethnicity and race as requested.
4. Enter your preferred language of communication, then proceed to the Physical Address section. Fill in your street address, city, state, and zip code.
5. Complete the Mailing Address section if it is different from your Physical Address. Otherwise, indicate that it is the same.
6. Provide your home telephone number, cell phone number, alternate phone number, and email address for contact purposes.
7. Fill in your Employment Information, including your employer, occupation, and work phone number.
8. Complete the Emergency Contact section by providing the name, phone number, and relationship of a person to be contacted in case of emergency.
9. Indicate if your visit is related to a Worker’s Compensation claim by checking the appropriate box.
10. If applicable, fill out the Guarantor Information section where the person responsible for the patient's finances is listed, including their name, contact information, and relationship to the patient.
11. Complete the Patient Outreach section to give permission for the institute to contact you for appointment reminders and surveys.
12. Review the Billing Policies and sign at the indicated signature section to acknowledge your understanding and agreement.
13. Read and agree to the E-Prescribing Information and Patient Consent by signing where indicated.
14. Finally, read the Patient Care Statement carefully and sign to acknowledge your understanding of the policies and practices.
15. Once the form is completed, you can save your changes, download a copy, print the packet for your records, or share it as needed.

Get started now by accessing the Cardiovascular Institute of the South New Patient Packet online!