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How to register as a new patient

Note: These files are in PDF format. If you do not have Adobe Reader on your computer, you can download it for free by clicking here >> .

1. If you have not already scheduled an appointment with us, please call our office at
   480-785-SKIN (7546). You will need the following basic information: 
   • Name
   • Date of birth
   • Insurance information (if applicable)
   • Phone number
   • Email address (if you would like to communicate with our office electronically).
2. Please print out the following forms and bring in a completed copy to your visit. Completing this paperwork in advance will save you time at our offices.
   • Registration Form >>
   • Insurance Form >>
   • Medical History >>
     
   • Please Bring Your Insurance Card
     
3. Please read and review the HIPAA document:
   What is HIPAA? HIPAA is the Health Insurance Portability and Accountability Act, a federal law that:
   ·  Protects the privacy of a patient’s personal and health information
   ·  Provides for electronic and physical security of personal and health information
   ·  Simplifies billing and other transactions: 
   • HIPAA Notice>>
4. Congratulations, you have completed the New Patient Registration! Please remember to bring in your completed forms to save time at your first appointment.

We look forward to seeing your very soon!