Occfit solutions 2025

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4.8 out of 5

30 votes

The document is a Patient Registration Form for Orthopedic Footwear & Bracing, detailing customer and insurance information, physician approval requirements, and various medical conditions related to foot and body pain. It includes sections for measurements, shoe size conversions, and a selection of footwear styles and colors. Additionally, it outlines the processing time for shoe orders and provides options for back and joint support products.

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Click ‘Get Form’ to open the Patient Registration Form in the editor.
Begin by filling out the Customer Information section. Enter your company name, personal name, address, city, state, zip code, phone number, and email address.
Proceed to the Date of Birth field and enter your birth date accurately.
In the Insurance Information section, provide details about your primary insurance company, member ID number, insured's name, group number, and their date of birth.
Complete the Physician Information section by entering your physician's name, address, phone number, and fax number. Ensure you have their approval before proceeding.
Check all applicable boxes regarding your medical history and work conditions that may affect your footwear needs.
Fill in your measurements: height, weight, and shoe size in the designated fields.
Finally, review all entries for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (30 Votes)
2016	4.3 Satisfied (40 Votes)

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