PATIENT FORMS

Follow the links below for our New Patient Paperwork which is needed at your first appointment. These forms are available online as a PDF file or at our front desk upon check-in. You may fill the forms our prior to your appointment.

Our Patient Handbook includes HIPAA / Privacy Act statement, Patient Bill of Rights, Financial Policy, Pain Medications & Acknowledgement, and our Pre-Procedure Instructions. All which need to be signed prior to your procedure. 

Our Patient Registration forms include Patient registration, Authorization to discuss, release, and obtain medical information, and notice to patients.  All which need to be filled out and signed prior to your procedure. 

QUICK LINKS
OUR ADDRESS

15547 North Reems Rd.

Surprise, AZ 85374

13575 W. Indian School Rd.

Litchfield Park, AZ 85340


Tel:  623-535-9777

Fax: 623-236-3179

OPENING HOURS

8:00 AM - 4:30 PM

Tuesday

8:00 AM - 3:00 PM

Wednesday

Home    About    Contact   Sitemap   Privacy Policy