FREDERICKSBURG ORTHOPAEDIC ASSOCIATES PC PATIENT 2025

1. Click ‘Get Form’ to open the FREDERICKSBURG ORTHOPAEDIC ASSOCIATES PC PATIENT form in the editor.
2. Begin by entering your personal information in the 'PATIENT INFORMATION' section. Fill in your last name, first name, middle initial, home phone, birth date, age, and cell phone number.
3. Indicate your sex and marital status by selecting the appropriate options. Provide your race and ethnicity by checking the relevant boxes.
4. Complete your mailing address and physical address details, including city, state, zip code, and county/city. Don’t forget to add your email address and employer information.
5. If applicable, fill out the section for patients under 18 years old by providing parental information such as names, addresses, SSNs, and employers.
6. In the 'INSURANCE INFORMATION' section, provide details about your primary insurance provider along with subscriber information. Indicate if you have Medicare coverage.
7. Finally, read through the consent statement at the end of the form. Sign and date it to confirm that all provided information is accurate.

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