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PATIENT INFORMATION Patients Last Name: Is this your legal name? Yes First:Middle Initial:Marital Status (circle one):Preferred Name:Birth date:Age:Sex:Single/ Married /Divorced /SeparatedStreet Address:Email
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To fill out single, indicate that you are not currently married or in a domestic partnership.
02
To fill out married, indicate that you are legally married and provide the necessary information about your spouse.
03
To fill out divorced, indicate that you were previously married and provide the date and place of the divorce.
04
To fill out separated, indicate that you are legally separated from your spouse but not yet divorced and provide the necessary information about the separation.

Who needs single married divorced separated?

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Anyone who is filling out a form or document requiring marital status information needs to indicate whether they are single, married, divorced, or separated.
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Single, married, divorced, and separated are all marital statuses that individuals can identify as on official documents and forms.
Individuals who are filling out official documents or forms that require them to identify their marital status are required to choose between single, married, divorced, or separated.
To fill out single married divorced separated, simply choose the option that best describes your current marital status.
The purpose of single married divorced separated is to provide an accurate representation of an individual's current marital status for official records and forms.
The only information required to be reported on single married divorced separated is the individual's current marital status.
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