Get the free New Patient Registration Packet - Richichi Family Health

1217 Piper Blvd, Suite 101, Naples, FL 34110 pH: (239) 514-2005 Fax: (239) 593-0067 www.RichichiHealth.com Chichi Family Health PATIENT INFORMATION Thank you for choosing CHICHI FAMILY HEALTH. In

How to fill out new patient registration packet

How to fill out a new patient registration packet:

1. Obtain the new patient registration packet from the front desk of the healthcare facility or download it from their website.
2. Read the instructions carefully to understand the required information and documents.
3. Fill out personal information accurately, including your full name, date of birth, address, phone number, and email.
4. Provide your health insurance details, including the policy number, group number, and the name of the insurance company.
5. Fill in your medical history, including any pre-existing conditions, allergies, surgeries, or medications you are currently taking.
6. If applicable, provide emergency contact information, including the name, phone number, and relationship of the person to be contacted.
7. Sign and date the registration form in the designated areas.
8. Attach any necessary documents requested in the packet, such as copies of your insurance card, identification, or referral forms.
9. Review the completed form to ensure all the information is accurate and complete.

Who needs a new patient registration packet:

1. New patients who have never been seen at the healthcare facility before.
2. Individuals who have not visited the healthcare facility in a significant amount of time and need to update their information.
3. Patients who have recently changed their insurance provider and need to provide updated information.
4. People seeking specialized services or consultations at the healthcare facility for the first time.
5. Individuals who have been referred to the healthcare facility by another medical professional and need to establish a new patient relationship.

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