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Today's Date: NEW PATIENT INFORMATION Welcome to our office. We appreciate the confidence you place with us to provide dental services. To assist us in serving you, please complete the following form.
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How to fill out new patient information
How to fill out new patient information
01
Start by gathering all the necessary documents and information, such as the patient's personal details, contact information, and medical history.
02
Begin filling out the new patient form by entering the patient's full name, date of birth, and gender.
03
Provide the patient's residential address, email address, and phone number for contact purposes.
04
Include emergency contact information in case of any unforeseen circumstances or emergencies.
05
Proceed to enter the patient's medical history, including any pre-existing conditions, allergies, medications being taken, and previous surgeries.
06
If applicable, provide details of the patient's primary care physician or any referring doctors.
07
Sign and date the form to certify the accuracy of the provided information.
08
Review the completed form to ensure all required fields are filled out correctly and legibly.
09
Submit the form to the appropriate healthcare provider, such as a doctor's office, hospital, or clinic.
Who needs new patient information?
01
New patient information is needed by healthcare providers, such as doctors, hospitals, and clinics, when a patient visits them for the first time.
02
It is required to establish the patient's personal and medical background, ensuring proper care and effective communication between the patient and healthcare professionals.
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