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General Information Name: Address: Phone: O.K. to call? Yes No O.K. to call? Yes No Date of Birth: Social Security #: Marital Status: If applicable: Spouses Name: Children's Names and Ages: CONFIDENTIAL

How to fill out new patient packet

How to fill out a new patient packet:

1. Start by reviewing the instructions provided in the new patient packet. It will typically contain information about the required documents and forms that need to be filled out.
2. Gather all the necessary documents, such as identification, medical insurance information, and any relevant medical records or referrals.
3. Begin by filling out the personal information section, which may ask for details like your name, address, date of birth, and contact information.
4. Move on to the medical history section, where you will be asked to provide information about past illnesses, medications, allergies, and any previous surgeries or medical procedures.
5. Fill out the insurance section, providing details about your primary and secondary insurance policies, if applicable. Be sure to include any necessary identification numbers or group codes.
6. If there is a section for emergency contacts, provide the requested information for individuals who should be contacted in case of an emergency.
7. Some new patient packets may include a consent form, which will require your signature to authorize the healthcare provider to treat you and access your medical records.
8. Carefully read through all the forms before signing, ensuring that you understand the content and agree to the terms stated.
9. Once you have completed all the required sections, double-check for any missing information or errors. This will help to avoid delays or confusion during your first visit.
10. Return the fully filled out new patient packet to the healthcare provider's office ahead of your scheduled appointment.

Who needs a new patient packet:

1. Individuals who have scheduled an appointment with a new healthcare provider or clinic.
2. Patients who are new to a particular medical practice and have not filled out their paperwork previously.
3. Individuals who have not visited a specific healthcare provider in a long time and need to update their information and medical history.

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