New Patient
Enter manually or drop a referral PDF to auto-fill, then verify and save.
← Dashboard
Manual entry
Upload (optional)
Drop a referral PDF to auto-fill fields.
📄
Drop PDF here
or
browse
Waiting for PDF…
0%
PDF uploads to Storage automatically when you save.
Clear PDF
Reset
Verify Patient Details
Confirm the info below before saving.
Patient Details
First Name
Last Name
Date of Birth
Phone
Cell
Insurance
Subscriber / Member ID
Address
Address 2 (optional)
City
State
ZIP
Country
Address saves as structured data.
Referral Details
Referring Provider
Referring Facility
Facility Phone
Facility Fax
Referral Date
Reason / Diagnosis
Save Patient to CRM