To save time during your first visit, please fill out and return these forms or bring the completed forms with you at your appointment. You can return them by fax to (480) 883-7240.

You will need a PDF reader to view these files. You can download Adobe Reader for free.

Health History Questionnaire (HHQ) – The completed HHQ is required for all new patients. Please fill it out as completely and honestly as possible. Your information will be kept secure at all times.

Insurance Form – If you have insurance, please fill out this form so we can let you know what services will be covered. We will also need a copy of the front and back of your insurance card, so please fax that to us or bring your card with you on your first visit.

Consent for Use and Disclosure of Personal Health Information – By filling out this form you agree to allow our doctors to review your medical information. In the event that you need to see a different doctor in the future, signing this form also allows us to send your information to that doctor.

Notice of Privacy Practices (read only) – This form simply covers our privacy practices, ensuring you that your medical information will remain confidential. You only need to read through this document, you do not need to fill it out.

Physician Referral Form for MNT RD Services – This form must be completed by your doctor if you are referred to us for medical nutritional therapy.