| Name: | |
| E-mail: | |
| Phone: | |
| Message: | |
| Please allow 24 – 72 hours for a response to your email. If you have medical issues or more urgent concerns, please contact us at (520) 795-7729. For medical emergencies, please call 911. Thank you. |
|
Patient Registration
A Warm Welcome to Our New Patients
Patient Forms & Information
•New Patients: Please print, fill out, and bring the New Patient Forms with you to your first visit to our office.
•Please download forms from the links below. If you are an existing patient, you may also use these forms to update your information.
•Please arrive 15 - 20 minutes early for your paperwork to be processed and to keep your appointment running on time.
•Please bring your Photo ID and Insurance Card.
•For a list of Insurances accepted, click here.
NEW PATIENT FORMS
Registration
Medical History
HIPAA / Advance Directive
Credit Card On File Agreement
If the patient is under 18 years of age, please download and complete this form:
Consent for Treatment of Minor
Registration
Medical History
HIPAA / Advance Directive
Credit Card On File Agreement
If the patient is under 18 years of age, please download and complete this form:
Consent for Treatment of Minor
We look forward to your visit. If you have any questions or concerns, please contact us at 520.795.7729.

We are conveniently located north of Tucson Medical Center, on Glenn Street
(between Swan and Craycroft).
Printable Map


