Create forms that users complete or print in Word - Office 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields, including your name, date of birth, and contact details. Ensure all sections are filled out completely for accuracy.
3. Proceed to the employment section. Indicate your current employment status and provide details about any injury related to your visit, including insurance carrier information if applicable.
4. Fill out the insurance information sections. Specify whether you have primary and secondary insurance, and provide the necessary policy holder details.
5. Complete the medical history section by checking any relevant conditions and listing medications you are currently taking. This helps ensure comprehensive care.
6. Review all entered information for completeness and accuracy before saving your document. Once finalized, save it to your computer.
7. Follow the instructions provided to email or fax the completed form as required.

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