NEW PATIENT:Appointment: Please bring the following items with...
Transcript of NEW PATIENT:Appointment: Please bring the following items with...
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NEW PATIENT:
Please bring the following items with you: □ A current picture ID like a passport or State ID or Drivers License
□ Your Social Security Card if you have one and birth certificate
□ Proof of address. Bring utility bill or phone bill.
□ Proof of Insurance if you have one
□ Proof of income > 2 pay stubs
> or a notarized letter stating how much you make a week.
Name: ________________________ Appointment: _________________ Dr.: _________________________
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PACIENTES NUEVO:
Se necesita traer estas cosas: □ Prueba de identidad como Licencia o Pasaporte
□ Tarjets de Seguro Social, si no tiene esta bien prueba de Certificado de Nacimiento
□ prueba de direccíon como una factura del Gas, Luz, o telefono.
□ Prueba de seguro medico
□ Prueba de Ingreso > 2 talonario del trabajo
> O una carta Notarizada que diga cuanto se gana a la semana
Nombre: ______________________ Cita: _________________________ Dr./Dra. ______________________