Form preview

Get the free New Patient Packet - Centura Health Physician Group

Get Form
Page 1. Page 1 of 6 ... Century Health Physician#39’s Group is committed to ensuring the privacy and ... IF PATIENT IS A MINOR (LESS THAN 18 YEARS Old): ... Form of contraception (if any): Planning
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign new patient packet

Edit
Edit your new patient packet form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your new patient packet form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing new patient packet online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Follow the steps down below to use a professional PDF editor:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit new patient packet. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.
It's easier to work with documents with pdfFiller than you could have ever thought. You may try it out for yourself by signing up for an account.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out new patient packet

Illustration

How to fill out a new patient packet:

01
Start by reading through the packet carefully. Make sure you understand each section and the information that is required.
02
Begin by filling out your personal information such as your full name, date of birth, address, and contact information. This will help the healthcare provider to identify you accurately.
03
Provide relevant medical history. Fill out any past or current medical conditions, surgeries, medications, and allergies that you may have. This information is crucial for the healthcare provider to understand your health background.
04
Include a list of any current medications you are taking, including the dosage and frequency. It is important to be thorough and provide accurate information to help avoid any potential drug interactions or complications.
05
Fill out any insurance information that may be requested. This includes providing your insurance provider's name, policy number, and group number if applicable. This information is necessary for billing purposes and to ensure that your insurance covers the services you receive.
06
Complete any additional sections that may be included in the new patient packet. This might include emergency contact information, primary care physician details, or any specific information requested by the healthcare provider.

Who needs a new patient packet:

01
Any individual who is visiting a healthcare provider for the first time or has never filled out their patient information before will need a new patient packet.
02
Additionally, individuals who are visiting a new healthcare provider or switching medical practices will also need to fill out a new patient packet to ensure their information is up to date and accurate.
03
It is important for both new and existing patients to fill out these packets to provide necessary information to the healthcare provider, ensuring they can provide appropriate care tailored to your specific needs.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
48 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

A new patient packet is a set of forms and documents that new patients need to fill out before their first appointment at a healthcare facility.
New patients are required to fill out and file the new patient packet before their first visit to a healthcare facility.
New patients can fill out the new patient packet either physically by hand or electronically through an online portal provided by the healthcare facility.
The purpose of the new patient packet is to collect necessary information about the patient's medical history, insurance details, and contact information to ensure a smooth and efficient healthcare visit.
The new patient packet typically includes sections for personal information, medical history, insurance details, emergency contacts, and any specific health concerns the patient may have.
Once your new patient packet is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.
Yes. By adding the solution to your Chrome browser, you can use pdfFiller to eSign documents and enjoy all of the features of the PDF editor in one place. Use the extension to create a legally-binding eSignature by drawing it, typing it, or uploading a picture of your handwritten signature. Whatever you choose, you will be able to eSign your new patient packet in seconds.
You can easily create your eSignature with pdfFiller and then eSign your new patient packet directly from your inbox with the help of pdfFiller’s add-on for Gmail. Please note that you must register for an account in order to save your signatures and signed documents.
Fill out your new patient packet online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.