FREE 3+ Patient Intake Forms in PDFMS WordPPM 101: How To Create A Successful Work Intake Process On 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the Intake Form. Fill in your last name, first name, and the last four digits of your social security number. Provide your phone number, email address, and mailing address including city, state, and zip code.
3. Complete the sections regarding your DWC number, date of injury, employer at the time of injury, and whether you are currently working. If applicable, indicate any other employers you were working for when injured.
4. In the Treatment and Other Claim Information Form, list all doctors, hospitals, or clinics that have treated you. Include their names, addresses, phone numbers, and fax numbers.
5. For the HIPAA Authorization form (OIEC-31), ensure you complete all sections related to your health information disclosure preferences.
6. Finally, review all forms for accuracy before signing and dating them. Once completed, print the forms to sign them physically.

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