Please click on the desired link below to download a pdf version of our forms.
* Fill out forms online and print directly *
* To save to your computer with filled in data, click Print, then change from a printer to ‘Save as PDF,’ then click ‘Save’ *
- New Patient Information Packet
- Patient History Form
- New Patient Demographic Form
- HIPAA Record Release Form
- HIPAA Medical Info Release Form
- Statement of Financial Responsibility
- Notice of Privacy Practices
- Receipt of Privacy Practices Form
- Fasting Lab Directions
- Treadmill Instruction Sheet
- Treadmill Release Form
- Mail order Rx Instructions
Flu season is in full-swing and is quite active. Please call to get your injection while supplies last
Pneumonia Vaccination Information
The Advisory Committee on Immunization Practices (ACIP) now recommends
Prevnar 13 for specific adults aged 65+
Patients who are 65 years of age or older are at increased risk for pneumococcal pneumonia. Risk increases even further for patients with the presence of chronic conditions such as Diabetes, Cardiovascular Disease and Chronic Pulmonary Disease.
The new PVC13 (Prevnar) vaccine is now available at our office. It has been shown to be “significantly effective” against community acquired pneumonia.
Please see the below links for detailed information on the vaccine:
Due to the complex information outlined in the link to the Centers for Disease Control website, we have summarized the recommendations below.
You should consider getting the PVC13 vaccine if:
Aged 65+ and have never had ANY pneumonia vaccine
Aged 65+ and had your last pneumonia vaccine over 1 year ago
If you have questions as to whether or not you are eligible for the vaccine, or if you wish to schedule your vaccination, please call our office at 602-522-1900.
This vaccine is covered 100% by Medicare Part B.
We currently have the vaccination available to you here at our office.
June Lunch Sign up Link: https://www.signupgenius.com/go/10c094ca9ac2aa7fd0-june2
July Lunch Sign up Link: https://www.signupgenius.com/go/10C094CA9AC2AA7FD0-july2