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Goshen Pediatrics, PC PATIENT REGISTRATION FORM Patient Information (Full legal name must be used, no nicknames) Last Name:First Name:Date of Birth:Age:Middle Initial: Gender (please circle one):
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Visit the website goshenpediatrics.com
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Click on the 'New Patient Forms' tab
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Fill out the required information on the form, such as name, address, date of birth, etc.
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Anyone who is a new patient at Goshen Pediatrics PC and needs to fill out the necessary forms should visit the website.
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Goshen Pediatrics PC is a medical practice that provides pediatric healthcare services, including routine check-ups, vaccinations, and treatment of illnesses for children.
Patients or guardians seeking pediatric care for their children are required to fill out the new patient forms on the Goshen Pediatrics PC website.
To fill out the forms, visit the Goshen Pediatrics PC website, download the forms, and provide accurate information regarding your child's health history, insurance information, and personal details.
The purpose of these forms is to gather essential information about new patients to ensure efficient and appropriate healthcare delivery at Goshen Pediatrics.
The forms typically require information such as the child's name, date of birth, previous medical history, immunization records, and parental contact information.
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