Get Appointment Scheduling Form

Filling out the Appointment Scheduling Form online is a straightforward process that ensures your appointment is scheduled efficiently. This guide will walk you through each section of the form, providing clear and concise instructions to make the experience easier for you.

Follow the steps to complete your appointment scheduling form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the 'Patient Name' field with the full name of the patient. This information is crucial for identifying and scheduling the appointment correctly.
3. Next, enter the 'Patient Date of Birth.' This helps verify the patient's identity and ensure accurate record-keeping.
4. Provide an email address in the 'E-mail' field to receive confirmations and updates regarding the appointment.
5. Input the 'Phone' number to facilitate communication about the appointment. You can also include a toll-free number if applicable.
6. Select your preferred method of appointment confirmation by checking the applicable boxes, such as 'Contact Parent Directly,' 'Call MD Office,' or 'Fax Appointment Information.'
7. Fill in the 'Referring Physician' section with the doctor’s name and contact information, including phone and fax numbers if available.
8. Detail the 'Diagnosis' relevant to the appointment, which provides context for the specialist.
9. Complete the 'Patient Address' section to ensure proper mailing information for any necessary documents.
10. Specify the 'Guarantor Name' and 'Guarantor Date of Birth' for billing purposes.
11. Provide 'Insurance' information including 'Policy Number' and 'Group Number' if applicable.
12. Indicate the preferred day and time for the appointment by providing your selection in the 'Preference of day/time' section.
13. List any 'Previous related studies' that may assist the specialist in evaluating the patient’s condition.
14. Use the 'Comments' section to include any additional notes or questions you may have.
15. Once all fields are filled, you can save changes, download, print, or share the form as needed.

Take the next step to secure your appointment — fill out the form online today.