Get Wakemed Wmc-3116 2013-2026

Filling out the WakeMed WMC-3116 form online is an important step in the registration process for outpatient rehabilitation services. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the WakeMed WMC-3116 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of your initial appointment in the designated field.
3. Fill in your personal details including your name, date of birth, social security number, age, race, sex, and marital status.
4. Provide your contact information, including home phone, cell phone, and any other contact numbers you wish to include.
5. Optional: Enter your email address and mailing address, ensuring accuracy in the city, state, and zip code fields.
6. If your physical living address differs from your mailing address, make sure to fill that out in the appropriate fields as well.
7. Complete the employer information section, including your employer's name and their contact details.
8. Enter your primary and secondary emergency contact person's details along with their relationship to you and their contact numbers.
9. Select your preferred language for health care information from the provided options.
10. In the insurance data section, be sure to provide accurate information, including insurance name, subscriber details, and policy numbers.
11. Indicate whether this visit is related to an accident, and if so, fill out the accident information section in detail.
12. Enter the patient's signature and date at the bottom of the form to validate your submission.
13. Once you have completed all sections, you can save changes, download, print, or share the form for your records.

Complete your WakeMed WMC-3116 form online today for a smooth registration experience.