Forms

New Patient Registration

Please complete one of the following New Patient Registration Forms

If you’d like to download the forms instead, please click below and bring into our offices: 

Miscellaneous

Medical Records Release

Allergen Immunotherapy Consent Form

Allergy Extract Quote Received

Patient Disclosure

Permission To Treat A Minor

Telemedicine Informed Consent

Credit Card Authorization

Our Offices

  • SCOTTSDALE

    ⚲ 8140 E. Cactus Rd. Ste 710 Scottsdale, AZ 85260
    ☎ (480) 897-6992
    ☎ (480) 344-4465 (fax)
    ☎ (480) 839-1874 – Referrals Fax
    🗣️ Schedule: Monday – Friday

    GET DIRECTIONS

  • GILBERT/MESA

    ⚲ 4852 E. Baseline Rd. Ste 101 Mesa, AZ 85206-4604
    ☎ (480) 897-6992
    ☎ (480) 839-1874 (Referrals Fax)
    🗣️ Schedule: Monday – Friday

    GET DIRECTIONS

  • CHANDLER

    ⚲ 705 S. Dobson Rd. Chandler, AZ 85224-5657
    ☎ (480) 897-6992
    ☎ (480) 344-4465 (fax)
    ☎ (480) 839-1874 – Referrals Fax
    🗣️ Schedule: Monday – Friday

    GET DIRECTIONS

  • QUEEN CREEK / SAN TAN

    ⚲ 36245 N. Gantzel Building 6 San Tan Valley, 85140
    ☎ (480) 897-6992
    ☎ (480) 344-4465 (fax)
    ☎ (480) 839-1874 – Referrals Fax
    🗣️ Schedule: Monday – Friday

    GET DIRECTIONS

  • PHOENIX


    ⚲ 348 E. Virginia Ave. Phoenix, AZ 85004-1208
    ☎ (480) 897-6992
    ☎ (480) 344-4465 (fax)
    ☎ (480) 839-1874 – Referrals Fax
    🗣️ Schedule: Monday – Friday

    GET DIRECTIONS

MAKE AN APPOINTMENT

Telephones are answered from:
8am – 5pm (Monday – Thursday)
8am – 4pm (Friday)