Forms

Please read, fill out and sign the following forms before your first visit to Pinnacle Family Medicine. If you have questions, please call us at 623-935-9600 and we would be glad to help you complete the forms.

Required Forms

  • Patient Rights Regarding Medical Records, MS Word or PDF
  • Confidentiality and Privacy, MS Word or PDF
  • Patient Financial Responsibility, MS Word or PDF
  • New Patient Registration Form, MS Word or PDF
  • New Patient Registration Form (Spanish), MS Word or PDF

        choose the appropriate one:

  • Patient Medical History Form (for ages 13 and up), MS Word or PDF
  • Patient Medical History Form (Spanish), MS Word or PDF
  • Patient Medical History Form Pediatrics (for ages 0 to 12), MS Word or PDF
  • Patient Medical History Form Pediatrics (Spanish), MS Word or PDF

Optional Forms