Houston patient intake 2026

1. Click ‘Get Form’ to open the houston patient intake in the editor.
2. Begin by entering your personal information in the designated fields. Fill in your first name, last name, and initial, followed by your home address, city, state, and zip code.
3. Next, provide your contact details including home phone, work phone, cell phone, and email address. Ensure accuracy for effective communication.
4. Complete the insurance information section. Indicate whether you are the policyholder for primary and secondary insurance. If not, fill out the policyholder information section as required.
5. Review and sign the authorization and assignment section to allow payment of benefits directly to the medical facility. Make sure to date your signature.
6. Proceed through additional sections regarding medical history and treatment preferences. Answer all questions thoroughly to ensure comprehensive care.

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