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1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date in the designated field. Ensure you use the format mm/dd/yyyy for accuracy.
3. Fill in your full name, including last, first, and middle names. Make sure to double-check for any spelling errors.
4. Indicate your date of birth using the mm/dd/yyyy format. This is crucial for identification purposes.
5. Select your sex by checking either 'Female' or 'Male'.
6. Provide your Social Security number and address details accurately.
7. Complete the contact information fields, including home, daytime, and cell phone numbers.
8. Answer employment status and provide employer details if applicable.
9. Indicate how you were referred to the clinic by checking one of the options provided.

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