In an effort to provide you with as much information as possible and to ensure the minimal wait time for our patients, we have provided many of the medical forms we use in our health care clinic. We recommend you download and fill-in the necessary forms prior to your office visit. This will allow you to provide accurate information and speed up the treatment process.

Medical Records Release Form

This form allows one to request  medical records from another general medical doctor so they can be sent to our offices in preparation for a visit. This will help our Doctors have all the pertinent records of one’s medical history. Please print this form and take it to your other Doctor or Specialist prior to your office visit or fax it to (928) 774-0123.

Employer Referral Form

Employer’s medical authorization form for contracted and non-contracted services. Please print, sign, and send with the employee for requested services or fax it to (928) 774-0123

Notice of Privacy Policy

Please print and read this form so you are aware of our privacy policies. You do not have to bring in the form to your office visit. It is strictly to describe how medical information about you may be used and disclosed, and how you can get access to this information.

OSHA Questionnaire

Please call our offices at 928-527-8505 for release of confidential records. Thank you.

The above medical forms are downloadable in PDF files. You will need Adobe Acrobat reader in order to view them. If you do not have this program, click here to get a free copy of the software.