eSignature Pennsylvania Government Medical History Now

When a client enters information (such as a password) into the online form on , the information is encrypted so the client cannot see it. An authorized representative for the client, called a "Doe Representative," must enter the information into the "Signature" field to complete the signature.

A. If you need to print a document, you'll need to download the Adobe PDF Reader (free download from Adobe). To open any document on the page, go to the PDF file and click the PDF icon. For instructions on how to print or save PDF documents, go to , or see Adobe's instructions for PDF's here. Q. Which printer should I use? A. You can use a desktop or a color laser printer to print the documents with the PDF Reader. The color laser printer can be brighter and easier to see than a computer screen. Q. When can I get the documents printed? A. To begin, complete a free trial of Adobe Acrobat (PDF Reader). You can save a print job and print again. Please note: The trial period is only for new users or users upgrading from a previous version. If you already have Adobe Acrobat installed, you will need to purchase new software and re-activate the software. Q. When you click on the "print" button the PDF opens in the printer. When the page reaches the desired size, the page disappears. How am I supposed to save it? A. It is best to print the full size document to save as a new file, or you can print the document in its "native" format. Q. When printing in color, the page appears with only a few color tones (red, blue, green), and the image has a strange color tone (purple, greenish-purple). In what situations do I print the full color page and then save it as a new file? A. To save the full color page, first choose Print and set the printer to the color printer (or, if a...

You have 2 options: Use the form below to create a pdf and send it directly to us. Fill out the form below to send us a pdf of your signature. * Your Name: * Please provide your email address: * Your Email: * The email address will not be used in any way for marketing or sales purposes. If you are not sure which one you should use, you can contact us here and we will provide you with both options. * First Name:* Your last name: * Your Email: * Address: * City / State: * State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Québec Alberta Saskatchewan Yukon Territory * Zip/Postal Code: * Country: * United States Canada Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia...