Whalen & McElmoyle Family Medicine Whalen & McElmoyle Family Medicine 2026

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The document is a patient intake form for Whalen & McElmoyle Family Medicine, specifically designed for children under 18 years of age. It collects essential information such as primary and secondary insurance details, emergency contacts, medical history, and parental consent for treatment. The form also includes sections for HIPAA compliance and acknowledges the patient's rights regarding their protected health information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name at the top of the form. This is essential for identification purposes.
Fill in your primary insurance information, including your address, carrier, ID number, and policy holder details. Ensure accuracy to avoid processing delays.
Complete the emergency contact section with a reliable person's name and phone number.
If applicable, provide secondary insurance information following the same format as the primary insurance section.
In the medical history section, answer all questions regarding past medical conditions and allergies. Circle any relevant symptoms your child may have experienced.
Sign and date the release and assignment section to authorize medical information sharing necessary for insurance claims.
Finally, review all entered information for accuracy before submitting the form through our platform.

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Where are Whalen products made?

Located on the Eastern Shore of Maryland, The Whalen Company headquarters spans 144,000 square feet and is supported by 140 employees serving all of North America. The history of The Whalen Company underscores our commitment to purpose-driven engineering and operational efficiency.

Who is the founder of Whalen furniture?

Ken Whalen, the founder of Whalen Furniture, was passionate about getting people to push themselves beyond their preconceived limitations as well as encouraging them to work towards bettering their lives.

What is Whalen furniture made of?

Every piece of furniture we build is crafted from the finest materials, including quality hardwoods and premium wood veneers. Our functional components incorporate features found in the best furniture, such as adjustable European hinges, metal ball-bearing slides, and integrated lighting.

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