926 E. McDowell Road
Suite 134
Phoenix, Arizona 85006
(602) 288-0777
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FORMS

Patient time and convenience is important to us.  To expedite the patient experience on appointment day, we have provided commonly used forms to print, complete and return at the appointment.

Our statement regarding the handling of your medical information in compliance with HIPAA regulations.

Gynecological Patient Forms
Please arrive 30 minutes before your appointment time so that we may prepare information for the clinical visit.

Annual Medical History
Patient Registration and HIPAA
Practice Agreement

Obstetric Patient Forms
Please arrive 30 minutes before your appointment time so that we may prepare information for the clinical visit.

Patient Registration and HIPAA
Annual Medical History
Safe Medications During Pregnancy
Practice Agreement

Medical Records
Patients may request medical records to be sent to our office from another office, please print the Medical Records Release form, complete it, and fax, deliver or mail it to the office which currently has your medical records.

Blood Transfusion Refusal Consent form

Misc. Forms and Letters
We offer services for patients who require forms and/or letters completed during care. Fees for this service are due from the patient prior to the release of the form/letter. These forms include, but are not limited to:

  • Disability Forms
  • FMLA Forms
  • Leave of Absence Forms
  • Letters regarding flying and/or airline tickets
  • Letters regarding the coverage of birth control pills used for reasons other than birth control
  • Letters to employers
  • Completion of Merk Medco Form

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