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CENTER FOR WELLNESS AND HEALING, P.A. P O Box 8406 Houston, Texas 77288 713 520 9611 713 456 2929 Fax cwh2004 aol.com NEW PATIENT INFORMATION Thank you for choosing the Center for Wellness and Healing.
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Start by filling in your personal information such as your full name, date of birth, address, and contact number.
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Provide your insurance information if applicable. This includes the name of your insurance provider, policy number, and primary care physician.
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Fill in your medical history, including any current or past medical conditions, surgeries, allergies, and medications you are taking.
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Provide information about your emergency contact person, including their name, phone number, and relationship to you.
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Sign and date the form to indicate your consent and acknowledgement of the information provided.
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Remember to bring any necessary identification documents such as your ID or driver's license.
Who needs new patient information?
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Any individual who is visiting a healthcare provider for the first time needs to fill out new patient information.
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This is applicable to all age groups, including adults, children, and elderly individuals.
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New patient information is required for various healthcare settings such as hospitals, clinics, doctors' offices, and dental practices.
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