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patient forms

Important Forms in Mesa and Chandler, Arizona

For Your Convenience

For added convenience we have made our patient forms available for you to print and fill out in your own home. Although this is not required, bringing these completed forms with you to the clinic will save you time on your first visit.

Simply open/print the PDFs below and bring the completed forms with you when you come in for your appointment.

English

Patient Agreement & Consent

Download PDF

Notice of Privacy Practices

Download PDF

Financial Policy

Download PDF

Notice of HIE

Download PDF

Spanish

Acuerdo del Paciente

Descargar PDF

Prácticas de Privacidad

Descargar PDF

Política Financiera

Descargar PDF

Aviso de HIE

Descargar PDF

Forms Archive