First Time Visit to Our Practice
PLEASE READ CAREFULLY
What do I need to bring to my first visit ?
- All insurance and prescription cards. It is also suggested that you bring a list of all prescribed and over the counter vitamins or supplements that you are currently taking.
- Bring copies of medical records or test results or ensure that your physicians send these to our office at lease one week prior to your scheduled appointment.
- Our fax number is (480) 614-0353.
- Bring a referral from your health plan if one is required, or ensure that authorization has been obtained by your primary care physician, if one is required.
Please print, fill-in, and sign all the documents of the New Patient Registration Packet. Please bring ALL these completed and signed documents to your first visit so that they may be scanned into your medical record. Our New Patient Registration Packet is provided as an online fillable form as well as an Adobe PDF for your convenience.
| Form | Online Form | Adobe PDF |
|---|---|---|
| New Patient Registration | Complete & Submit Online | Download PDF |
*Note: Please review our Privacy Practices. It is not required that you print the privacy practices, they only need be reviewed.
Why do we need you to send your records beforehand?
At Four Peaks Neurology, we like to get to know our patients even before they come in to our offices for the first time. This helps us prepare for your arrival to not only provide you with the best care that you deserve but also helps minimize errors such as accidental referrals which could be costly.