Now accepting Telehealth appointments. Schedule a virtual visit. Text us at 928.569.7204. Text messaging available M-F 8:30a-4:30p

Patient Registration Forms


 

Please select the appropriate form below for patient registration at our office. 

 

In Office Patient Forms:

 

REGISTRATION FORM

MEDICAL HISTORY FORM

AUTHORIZATION TO RELEASE MEDICAL RECORDS

LATE OR NO SHOW

 

Mobile Care Patient Forms:

 

MEDICAL HISTORY FORM

REGISTRATION FORM

What we offer

Services

Location
Integrated Premier Group Specialty
2075 Cottonwood Dr.
Tempe, AZ 85282
Phone: 480-692-7568
Fax: 480-307-6676
Office Hours

Get in touch

480-692-7568