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REGISTRATION FORM Date: PATIENT INFORMATION Patient s last name: First: Is this your legal name? Yes Middle: If not, what is your legal name? Mr. Mrs. Marital status (circle one) Miss Ms. (Former
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Ed S refers to the Education Savings Account, which is a tax-advantaged account created to save for future education expenses.
Parents or guardians who want to save for a child's education expenses can open and contribute to an Education Savings Account.
To fill out an Education Savings Account, individuals need to provide personal information, including the beneficiary's name and Social Security number, and specify the contribution amount.
The purpose of an Education Savings Account is to save for qualified education expenses, including tuition, fees, books, supplies, and certain room and board costs.
Information such as the contributor's name, beneficiary's name, contribution amount, and account details must be reported on an Education Savings Account.
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