The following forms are available to expedite the registration process. There are 5 online registration forms to complete. If you fill out the forms online, please remember to print them out and bring them with you to your child’s office visit. Don’t forget to bring a copy of your child’s insurance card, too! 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 REGISTRATION FORMS

1 Patient Registration

2 HIPAA

3 Insurance Questionnaire

4 Consent for Messages

5 Patient/Family Medical History


FORMAS DE REGISTRACION EN ESPANOL

1 Informacion del Paciente

2 Formulario de Consentimiento del Paciente (HIPAA)

3 Cuestionario de Aseguranza

4 Consentimiento para Recordatorios

5 Historial Medico