Get Fl Dunedin Pediatrics & Family New Patient Registration Form 2015-2025

Completing the FL Dunedin Pediatrics & Family New Patient Registration Form online is an essential step in ensuring a smooth onboarding process for your child. This guide will provide you with straightforward instructions on how to fill out each section of the form with ease.

Follow the steps to successfully complete the registration form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Fill in your child's information, including their name, date of birth, and sex, ensuring accuracy for effective communication.
3. Provide the primary address of the family, including city and zip code, to ensure correct contact and billing information.
4. Enter the names and cell phone numbers of the parents or guardians. Include a home phone number if applicable for alternate contact.
5. List an emergency contact who is not a parent, along with their relationship to the child and phone number for urgent communication.
6. Include the parent’s email address and select whether you authorize the use of this email for communication purposes.
7. Identify the pharmacy you use, along with its cross streets, to streamline medication management.
8. Read and acknowledge the Patient Phone Message Consent section by documenting your consent to leave messages as described.
9. Defer to the Sharing of Medical Information and consent for treatment sections where you must grant permission for medical discussions and treatments.
10. Fill out the primary insurance information, including the insurance name, subscriber’s name, ID number, and relationship to the insured.
11. Review the patient authorizations and initial where required to consent to processes such as ePrescribing and information sharing.
12. Complete the final sections for acknowledgment of receipt of privacy practices and non-solicitation, signing and dating where indicated.
13. After completing the form, save your changes. You can download, print, or share the document as needed.

Get started on completing your FL Dunedin Pediatrics & Family New Patient Registration Form online today!