415 North Center St Suite 300 Hickory, NC 28601 Phone: 8283283300 Fax: 8283289101 Patient Interview 2025

1. Click ‘Get Form’ to open the Patient Interview form in the editor.
2. Begin by filling out the 'Patient Information' section. Enter your first name, last name, medical record number (MRN), date of birth, and age. Use the 'Notes' field for any additional information you wish to provide.
3. In the 'Contact Preference' section, select your preferred method of communication by checking the appropriate box for email or telephone.
4. Proceed to the 'Allergies' section. Indicate if you have any known allergies by checking the relevant boxes or selecting 'Patient has no known allergies'.
5. Continue through each section including 'Past or Present Medical Conditions', 'Diagnostic Studies/Tests', and 'Family Medical History', ensuring all relevant fields are completed accurately.
6. Fill out your social history, including occupation and marital status. Provide details about alcohol and tobacco use as applicable.
7. Complete the 'Review Of Systems' section by indicating any symptoms you may be experiencing.
8. Finally, review all entered information for accuracy before signing and dating at the end of the form.

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