Central scheduling one step form - Kettering Health Network 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'Patient Name' and 'DOB' fields. Ensure all required fields are completed accurately.
3. Select your preferred method of contact by checking the appropriate box for Home, Work, Cell, or Email.
4. Enter the patient's Social Security Number (SSN) and any relevant ICD10 codes along with written diagnosis(es).
5. Indicate the patient's sex by selecting either Male or Female. Fill in the precertification number and insurance details including expiration date.
6. In the lab section, check all applicable tests needed for the patient. Be sure to review each category carefully.
7. Complete any special notes or additional information as necessary before signing at the bottom of the form.

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