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Click ‘Get Form’ to open the New Patient Packet in our editor.
Begin by filling out your personal information in the 'Patient Information' section. Include your last name, first name, middle initial, address, city, state, zip code, marital status, sex, date of birth, and social security number.
Next, provide your contact details including home phone number, cell phone number, work number, and email address.
In the 'Pharmacy Information' section, enter the names and phone numbers of your local and mail-in pharmacies. This is crucial for electronic prescriptions.
Complete the 'Billing Information' section if someone other than you is responsible for payment. Include their name, date of birth, address, social security number, employer details and relationship to you.
Review the cancellation policy carefully and ensure you understand it before signing at the end of the document.

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