Get the free New Patient Information Package PDF - NeurologyConcerns.com
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The Neurology Center Allen M. Clifton, M.D. 200 Capri Isles Blvd Suite 7D; Venice, FL 34292 Phone: (941) 485-2220 Fax: (941) 485-2150 Last Name: DOB First Name SS# M.I. Gender Male/Female Date: Single
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How to fill out new patient information package
How to fill out the new patient information package:
01
Begin by carefully reading and understanding each section of the package.
02
Provide accurate personal information such as your full name, date of birth, and contact details.
03
Fill in your medical history, including any past illnesses, surgeries, or allergies. Be thorough and provide as much detail as possible.
04
List any medications you are currently taking, including dosage and frequency.
05
Provide information about your primary care physician or any specialists you are seeing.
06
If applicable, provide insurance information, including policy numbers and contact information.
07
Answer any additional questions or sections specific to the healthcare provider or medical facility.
08
Sign and date the form to acknowledge that the information provided is true and accurate.
09
Review the completed package to ensure all sections have been filled out properly.
Who needs a new patient information package:
01
New patients who are seeking medical care from a healthcare provider or medical facility.
02
Patients who have never been to a particular healthcare provider or medical facility before.
03
Patients who are transferring their care from one healthcare provider or medical facility to another.
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