Example Data

Add New Patient

Personal Information

Basic patient details. Name is required, and either email or phone number must be provided.

First Name *

Last Name *

Phone

Date of Birth

Patient's date of birth for medical records

Address Information

Patient's residential address for billing and contact purposes.

Street Address

City

State

ZIP Code

Medical Information

Patient's medical history, allergies, and relevant health information.

Known Allergies

Include drug allergies, food allergies, and environmental sensitivities

Medical History

Include past surgeries, chronic conditions, and relevant medical events

Emergency Contact

Contact information for patient's emergency contact person.

Contact Name

Contact Phone

Additional Notes

Any additional information or notes about the patient.

Notes

Include any special instructions, preferences, or other relevant information