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At the doctor's office and pharmacy Share with your doctor a list of your current medicines, vitamins, herbs and supplements. Things you can do to prevent medication mistakes Whenever you get a new

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Step 1: Start by reading the instructions on the form. Make sure you understand what information you need to provide.

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Step 2: Fill in your personal information, such as your name, date of birth, and contact details.

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Step 3: If requested, provide your medical history, including any past illnesses, medications you are currently taking, and any allergies you may have.

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Step 4: Fill out the reason for your visit and any symptoms you are experiencing.

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Step 5: If applicable, provide your insurance information, including policy number and group ID.

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Step 8: Once you have filled out the form, submit it to the doctor's office either in person or through the provided channels.

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Anyone who is visiting a doctor's office for an appointment, whether it is a new patient or a returning patient, needs to fill out the form.

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