Patient Screening Form - CareNow 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information at the top of the form, including your name and date of birth. This ensures that your responses are accurately linked to your medical records.
3. Proceed to answer the screening questions regarding symptoms and recent travel. Select 'YES' or 'NO' for each question, ensuring you provide honest and accurate information.
4. In the section for patient demographics, fill in additional details such as contact information, marital status, and employment status. This helps in maintaining comprehensive records.
5. If applicable, provide details about any work-related injuries in the designated section. Be descriptive to ensure proper assessment.
6. Finally, review all entered information for accuracy before signing at the bottom of the form. Your signature confirms that all provided information is correct.

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