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Wichita Falls Art Association Gallery Artwork Intake Slip Please Print Name of Artist Number of pieces Fee paid for the following: $20 for two pieces for one month exhibit during the month of $35

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How to fill out intake slip v3

01

To fill out the intake slip v3, follow these steps:

02

Start by writing the date on the top right corner of the slip.

03

Enter your personal information, including your full name, address, and contact details, in the designated fields.

04

Specify the reason for your visit or consultation in the 'Purpose of Visit' section.

05

Provide any relevant medical history or current medications you are taking, if applicable.

06

Answer all the questions or sections provided, such as allergies, symptoms, or specific concerns you may have.

07

If there are any specific instructions or requests you have for the healthcare provider, ensure to mention them clearly.

08

Review the completed intake slip for accuracy and make any necessary corrections.

09

Once you have verified all the information, sign the slip at the bottom to indicate your consent and agreement with the provided information.

10

Submit the intake slip to the receptionist or healthcare professional as instructed.

Who needs intake slip v3?

01

Intake slip v3 is needed by individuals who are visiting a healthcare facility for the first time or require updated personal and medical information on file.

02

This includes new patients, returning patients who have had significant changes in their medical history or contact details, or those seeking specialized services for the first time.

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