Forms
NEW PATIENTS
New Patient Packet (All forms below combined in a consolidated download)
Patient Registration
Health History
Consent to Annual Administrative Fee
Easy Pay
Enrollment
Consent to Financial Policy
Notice of Privacy Practices
Acknowledgement of Privacy Practices
Records Release to LifeScape
EXISTING PATIENTS
Problem Checklist (must be completed for all LifeScape visits)
Records Release from LifeScape
Records Release to LifeScape
TRAVEL CLINIC
Pre-Travel Questionnaire
AESTHETICS
Consent to Treatment
ADVANCED DIRECTIVES / LIVING WILL
Arizona Compliant Life Care Planning Packet including Durable Health Care Power of Attorney, Living Will, Durable Mental Health Care Power of Attorney, Letter to Agent/Representative,and Advance Medical Directive Forms
All forms are in Adobe PDF format. You may download the latest version of Adobe Reader
here
.
Home
Medical Services
Primary Care
Concierge/Executive Health
Gynecology
Adolescent Health
Pediatrics
Sports Medicine
Diet and Nutrition
Skin Care
Travel Clinic
Psychology
X-Ray and Lab
Genetic Testing
Meet Our Staff
Susan S. Wilder, MD
William J. Strohman, MD
Natalie A. Suedekum, MD, CAQ
Kristen Valderhaug, MD
Laurie M. Pozun, DO
Norman J. Bizon, PA-C
Lisa K. Strohman, JD, PhD
Patient Information
Forms Center
Access Options
Annual Fee
Contact Us
See Our Facility
Maps and Directions
Products
All forms are in Adobe PDF format. You may download the latest version of Adobe Reader