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Fax to: 18004792562 Number of pages in fax: Phone: 18006451280Pediatric Outpatient Information Patient Name (First and Last) Date of Birth XX/XX/Address: City State ZIP Home Phone Work Houseparent/Guardian
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How to fill out fax to 1-800-479-2562

01
Start by writing your full name and address at the top of the fax sheet.
02
Below your information, write the date in the specified format (e.g., mm/dd/yyyy).
03
In the recipient section, write '1-800-479-2562' as the fax number.
04
You can leave the recipient's name blank or write 'Fax Service' or 'Receiver' as the recipient's name.
05
Add a subject or a brief description of the fax's content in the subject line.
06
Begin writing the main content of the fax below the subject line.
07
Ensure the content is clear, concise, and formatted appropriately.
08
If necessary, include any attachments or additional pages with the fax. Number the pages consecutively and indicate the total number of pages in the fax.
09
Review the fax for accuracy and completeness before sending it.
10
Once you're satisfied, place the fax sheet in the fax machine and follow the machine's instructions to send the fax.

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Fax to 1-800-479-2562 is a method of submitting documents or information through fax machine to the specified number.
Individuals or entities who are instructed to do so by the recipient of the fax.
Fill out the necessary information on the fax document and send it to the designated fax number 1-800-479-2562.
The purpose of faxing to 1-800-479-2562 may vary depending on the specific instructions provided by the recipient.
The information required to be reported on the fax document will be specified by the recipient.
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