Davam: Fill out & sign online

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Click ‘Get Form’ to open the davam com patient registration form in our editor.
Begin by filling out the 'Patient Demographics' section. Indicate how you heard about the clinic by checking the appropriate box. If applicable, specify if this is a work-related injury.
Enter your Social Security Number, marital status, first name, last name, middle initial, sex, date of birth, and contact information including address, home phone, cell phone, and email.
Provide your employer's details including name and address along with your work phone number.
List your primary care physician and indicate your race and ethnicity by circling the appropriate options.
If applicable, complete the 'Guarantor' section. If the guarantor is the same as the patient, check the corresponding box; otherwise, fill in their details.
Complete the 'Insured' section with relevant information. If it’s the same as the guarantor's details, check that box.
Finally, review all entered information for accuracy before signing and dating at the bottom of the form.

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