We look forward to meeting with you and want to make your first visit as comfortable as we can. For your convenience, we’ve provided a complete online patient registration which is easy to use from a computer, tablet or mobile phone. Please enter the requested information to help us assist you and save you valuable time on the day of your appointment. Information you enter is secure and will not be shared with anyone outside of our organization. Below for easy reference is a helpful list we created to give you an idea of what information you will need to have on hand when filling out the online registration form. The entire process should take you about 5 to 10 minutes but for patients that have more medical history to enter, it could take a little bit longer.
If you prefer to fill out a paper version of our registration, then you can download them by clicking on the links below. Please print and fill them out and send them to us prior to your appointment by either faxing or mailing them. Our fax number is (602) 279-5333 and our mailing address is, 6040 North 7th Street, Suite 105, Phoenix, AZ 85014 This will help get you in to see the doctor sooner.
If you have any questions, please feel free to contact us at (602) 277-7430. Our friendly staff is here to help you!
Thanks for doing this! It will help speed along your check-in process.
Click the Link below for our Secure Online Registration:
Information needed for online registration:
- Medical Insurance Information
- Pharmacy Information (Phone & Locations)
- Current Physicians (Names & Specialties)
- Medical Allergies
- Current Medications (Dose & Frequency)
- Prior Surgeries
- Current Medical Problems
- Family Medical History
*Please note that if you start the registration, you do not want close your browser down until you have submitted the form. The information you enter is temporarily saved in the browser but once you close it out, the information will be gone.