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Orthopedics East & Sports Medicine Center, Inc. Patient Registration Form Patient Information First Name:Middle:Last:Address:City:Email: Date of Birth:Cell #: (//Sex:)State Home #: (Race: Marital
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How to fill out patient info website formdocx
01
Start by opening the patient info website formdocx on your internet browser.
02
Look for the first section of the form where it asks for personal information such as name, address, contact number, and date of birth.
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Fill in your full name in the designated field. Make sure to input your first name, middle name (if applicable), and last name correctly.
04
Provide your complete residential address including the street name, city, state, and postal code.
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Enter your phone number in the format specified (e.g., with or without dashes).
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Input your date of birth using the prescribed format (e.g., MM/DD/YYYY).
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Move on to the next section of the form which may ask for additional personal details like gender, marital status, and occupation.
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Fill out these details accurately and accordingly.
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Proceed to the medical information section if applicable. This may require you to provide details about your medical history, current medications, allergies, and insurance information.
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Double-check all the information you have entered to ensure accuracy.
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Once you are satisfied with the filled form, click on the submission button or follow any additional instructions given on the website.
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Take note of any confirmation message or reference number provided upon successful submission.
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