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Patient Preference Form Date: Patient Name: Please check the box next to your preferred contact number. Home Phone: Work Phone Mobile Phone: Email Address: Emergency Contact Name: Emergency Contact

How to fill out patient preference form

How to fill out a patient preference form:

1. Start by carefully reading the form and familiarizing yourself with its sections and requirements.
2. Begin by providing your personal information, such as your full name, date of birth, and contact details.
3. Next, fill in your medical history, including any pre-existing conditions or allergies that may be relevant to your treatment or preferences.
4. If the form includes questions regarding your treatment preferences or goals, take the time to think about and provide clear and concise responses.
5. Be sure to review any instructions or guidelines provided to ensure your responses are accurate and complete.
6. In case there are sections requesting information about your preferred healthcare providers or facilities, list any specific preferences you may have.
7. If there is a section dedicated to specifying your communication choices, indicate your preferred methods, such as email, phone, or in-person consultations.
8. Double-check your answers to ensure they are legible, accurate, and reflect your true preferences.
9. Once you have completed the form, sign and date it as required.
10. If needed, make copies of the completed form for your records or to provide to your healthcare provider.

Who needs a patient preference form:

1. Individuals seeking medical treatment: Patient preference forms are useful for individuals who want to express their treatment preferences, goals, or healthcare provider preferences.
2. Patients with chronic or serious conditions: These forms can be particularly important for patients with chronic illnesses or serious medical conditions who want to provide clear instructions or express their treatment priorities.
3. Individuals undergoing elective procedures: Patients who are planning to undergo elective surgeries or procedures may benefit from filling out a patient preference form to communicate their specific requests or concerns.

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