Get Yale Pediatric Thyroid Center New Patient Form

Filling out the Yale Pediatric Thyroid Center New Patient Form online is a straightforward process designed to gather important information about new patients. This guide provides clear and supportive instructions to help you successfully complete the form with ease.

Follow the steps to accurately complete your new patient form.

1. Press the ‘Get Form’ button to access the new patient form and open it in your preferred editor.
2. Begin by entering the current date at the top of the form.
3. Indicate the appointment confirmation option by selecting either 'PHONE OPTION' or 'FAX OPTION', based on how you are contacting the center.
4. In the patient information section, provide the patient's name, date of birth (DOB), and address.
5. Enter the parent or guardian's name(s) and their contact phone numbers, including day, evening, and cell options.
6. If an interpreter is required, check 'Yes' or 'No' and specify the primary language if it is other than English.
7. Fill in the insurance company name and the identification number (ID#).
8. Provide a brief medical history and the reason for referral in the designated section.
9. Indicate if there was a hospital discharge by checking 'Yes' or 'No,' and if 'Yes', provide details of any specialty consulted.
10. List any labs, diagnostic imaging, or records being submitted with the form by checking the appropriate boxes.
11. Fill in the referring provider’s name, address, phone, and fax information as well as their optional email.
12. After completing all sections, review your entries for accuracy, then save changes, and prepare to download, print, or share the form as needed.

Complete your new patient form online today for a smoother appointment process.