top of page

PATIENT FORMS

Follow the links below for our New Patient Paperwork which is needed at your first appointment. Please fill out all forms 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 forms 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 forms need to be filled out and signed prior to your procedure. 

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

OUR HOURS

Litchfield Park:

7:30am - 5:30pm Tuesday

​

Surprise:

7:30am - 5:30pm Thursday

7:00am - 5:30pm Saturday

Home    About    Contact   Sitemap   Privacy Policy 

bottom of page