Forms

New Patient Registration
Please complete one of the following New Patient Registration Forms

Miscellaneous

Medical Records Release
Allergen Immunotherapy Consent Form
Patient Disclosure
Permission To Treat A Minor
Telemedicine Informed Consent
Credit Card Authorization
OUR OFFICES
Chandler office
Gilbert/Mesa Office
Phoenix Office
San Tan Office

Please be sure to fill out all English Forms under all Sections

he following forms are available for download in PDF format: New Patient Registration, Privacy Disclosure, Acknowledgement of Receipt of Privacy Policies, Consent for Disclosure of Information, Authorization to Release Medical Records, and Consent Form. Filling out these forms prior to your appointment will expedite your check-in process and help us serve you more efficiently at your new patient appointment. Please click on the link to each form to download it to your computer. Download the FREE Adobe Acrobat Reader to open and print the forms.

New Patient Registration Form

Privacy Disclosure/Consent

**Please note that the Acknowledgment of Receipt and Consent for Disclosure forms should be brought to your appointment. You should read the privacy disclosure and retain a copy for your records before signing the Acknowledgment and Consent forms **

OUR OFFICES
Chandler office
Gilbert/Mesa Office
Phoenix Office
San Tan Office

MAKE AN APPOINTMENT

Telephones are answered from 8am – 5pm, Mon – Thurs
8am – 4pm, Fri

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