Get the free Physician Selection Form

Select your primary care physician by filling in the information below. You can choose a different primary care physician for each member of your family or one to care for your entire family. This

How to fill out physician selection form

How to fill out Physician Selection Form

1. Obtain the Physician Selection Form from the relevant medical office or website.
2. Start filling out personal information at the top of the form, including your name, date of birth, and contact information.
3. Indicate your insurance information, if applicable, in the designated section.
4. Review the list of available physicians and their specialties.
5. Select your preferred physician by checking the appropriate box or filling in the physician's name.
6. Fill out any additional information required, such as medical history or current medications, if prompted.
7. Review the completed form for accuracy.
8. Submit the form as instructed, either online, via email, or in person.

Who needs Physician Selection Form?

1. Individuals seeking medical services or treatment who need to choose a specific physician.
2. Patients required by their insurance providers to select a physician.
3. New patients who are establishing care with a healthcare provider.

For pdfFiller’s FAQs

What is Physician Selection Form?

The Physician Selection Form is a document used to designate a specific physician or healthcare provider for the management of a patient's medical care.

Who is required to file Physician Selection Form?

Patients or their legal representatives are typically required to file the Physician Selection Form as part of the healthcare enrollment or treatment process.

How to fill out Physician Selection Form?

To fill out the Physician Selection Form, patients must provide personal information, select their preferred physician from a list, and sign the form to confirm their choice.

What is the purpose of Physician Selection Form?

The purpose of the Physician Selection Form is to ensure that healthcare providers are aware of the patient's chosen physician and to facilitate the coordination of medical care.

What information must be reported on Physician Selection Form?

The Physician Selection Form must report the patient's full name, contact information, the name of the selected physician, and any relevant medical history or special considerations.