Robert J McKenna, M D Santa Monica, CA - Providence 2026

1. Click ‘Get Form’ to open the New Patient Health Questionnaire in the editor.
2. Begin by filling out the Registration/Demographic Information section. Enter your name, today's date, address, date of birth, and social security number. Ensure all fields are completed accurately.
3. Proceed to provide your contact details including home phone, cell phone, email address, and driver's license information. Select your gender and primary language from the options provided.
4. In the Insurance Information section, input your primary and secondary insurance details along with group numbers and ID numbers as applicable.
5. Complete the Emergency Information section by entering a contact name, relationship, and their phone numbers.
6. Fill out the Medical History section detailing any current medical illnesses, past surgeries, hospitalizations, and lifestyle habits such as smoking or alcohol consumption.
7. Finally, review all sections for accuracy before saving or submitting your completed form through our platform.

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