(Pg 1) NP Info Form docx 2025

1. Click ‘Get Form’ to open the NP Info Form in the editor.
2. Begin by entering today's date at the top of the form. This helps keep your records organized.
3. Fill in the Patient Information section. Start with the patient's full name, including last, first, and middle names. Then, provide their mailing address and home address if different.
4. Enter the patient's birthdate and social security number if they are over 18 years old. Include primary and secondary phone numbers, selecting the appropriate contact type for each.
5. Indicate how you would prefer to receive appointment reminders by checking the relevant boxes for phone, text, or email.
6. Complete the Responsible Party/Guardian Information section if applicable. If this information is identical to the patient’s details, you may skip this part.
7. Provide Dental Insurance Information by filling in subscriber details and indicating if there is dual coverage.
8. Lastly, fill out Emergency Contact Information with names and phone numbers of individuals who can be reached in case of an emergency.

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