Sunday, May 19, 2013
   
Text Size
Hours: M-F 8am thru 5pm    Phone: 602.254.5561    Fax: 602.254.2185     Login

The following forms are available to expedite the registration process for new patients. Please print out and complete each of the four new patient registration forms, available in English or Spanish, and bring the completed forms, along with your child's insurance card, to your office visit. Please also take a moment to review our Notice of Privacy Practices for Protected Health Information online or a printed copy of this document is available upon your request.  If you have questions regarding these forms or your upcoming appointment, please contact us at 602-254-5561.

English

Patient Registration

Insurance Questionnaire

Consent for Reminders

HIPAA Patient Consent Form

Spanish

Informacion del Paciente

Cuestionario de Aseguransa

Consentimiento para Recoradatorio

Formulario de Consentimiento del Paciente (HIPAA)

Restore Default Settings

Login Form