Foothills Family Care
4530 E Ray Road, Suite 150
Phoenix, AZ 85044
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FORMS

Forms

These forms are in PDF format and can be opened with Adobe Reader. You can click here to download Adobe Reader.

New Patient Information and Registration Forms


All new patients should bring the following forms from the NEW PATIENT FORMS, completed, to your first appointment.



NEW PATIENT FORMS.pdf
3.6 MB


Other Forms


To request your medical records be sent from another provider to Foothill Family Care:

RECORDS RELEASE.pdf
265.3 KB


Informed consent this form allows you to name people who are allowed to receive information about your medical history due to HIPPA.

INFORMED_CONSENT.pdf
229.0 KB





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4530 E Ray Road, Suite 150 Phoenix, AZ 85044
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