Laramie Location 2025

1. Click ‘Get Form’ to open the Laramie Location document in the editor.
2. Begin by filling out the PATIENT INFORMATION section. Enter the child's first and last name, date of birth, and social security number. Ensure you select the correct sex and provide a preferred name if applicable.
3. Next, complete the Parent/Guardian details including their name, relationship to the patient, address, and contact numbers. Check the boxes for email preferences as needed.
4. In the EMERGENCY CONTACT section, provide a name and phone number of someone who can be reached in case of an emergency.
5. Fill out the INSURANCE INFORMATION section with details about the insured individual, including their full name, address (if different), insurance company name, policy number, and contact information.
6. Review all permissions regarding personal information communication and ensure that all necessary fields are completed before signing at the bottom of the form.

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