Download Patient Information Form

Medical Questionnaire Form

Completing paper forms

New Patient Registration forms must be filled out prior to your first visit. All fields need to be completed on both the Patient Information Form and the Medical Questionnaire. Please be as detailed as possible when completing the forms.

If your Primary Care Provider has referred you to our office, please make sure they have faxed a copy of the referral to 602-971-1556 especially if your insurance plan requires a referral for you to be seen by a specialist.

Patient portal instructions

Our office will send you a link via email to the patient portal when you are scheduling your first appointment. If you choose to complete your information on the portal (our preferred method) the paper forms will NOT need to be completed. Please complete the following sections:

  • Contact information (complete all applicable fields)
  • Insurance and Pharmacy (review information entered by office staff)
  • Medications
  • Allergies
  • Past Medical History
  • Skin Disease History
  • Social History
  • Family History

If you have any questions or need help accessing the portal; please don’t hesitate to contact us either by phone or on the contact page.