Patient Information

Paradise Valley Family Care wishes to make your visit as smooth and pleasant as possible.  As a new patient, you will be asked to complete some forms to help our staff and providers provide you with the best care.  There are also consent forms, HIPAA information, and Patient rights that are important for you and your family’s overall healthcare management.  For your convenience, we have provided these forms online to download in PDF format so that you may fill out prior to your visit.  This will let you focus on this important information and expedite your initial check in time.  Please call our office at 602-482-6100 with any questions regarding these forms.

Patient Forms (NEW PATIENT CHECKLIST)

Registration Form
Adult History
Pediatric History
Patient Contact Form (for Lab, Medical, and Financial purposes)
Medical Records Release Form
Consent to Treat a Minor
HIPAA Notice form

motor vehicle Accident (MVA) Forms

MVA Patient Agreement
MVA Patient Information Sheet
MVA Patient Insurance Info
MVA Patient Financial Liability Agreement
MVA MedPay Letter

Physical Medicine Forms

Physical Medicine Registration Form
Patient Agreement
Patient History
Informed Consent

Adobe Acrobat Reader is required to read the patient forms

cancellation of appointment policy

Please notify our office immediatley if you are unable to make your appointment. This will allow us time to give that appointment to a patient in need. Unless there is a valid emergency the day of your appointment, it is highly recommended to call our office at least 24 hours prior to your scheduled appointment date to avoid a fee of up to $70.

Health Insurance/payment

We gladly accept most insurance plans such as common major PPO plans including BCBS, AFMC, HealthNet, UHC, First Health, Coventry, CCN, PHCS, Beech Street, Great West, MultiPlan, and Medicare. We may accept other plans not mentioned here. We are more than happy to work with patients with health savings accounts as well as private pay patients. Please call our office at 602-482-6100 prior to your visit if you have any questions about your coverage.

Payment for co-pays and deductibles will be due at your office visit. Should you ask us to bill your co-pay, a service charge will be added. Payment plans are available if arrangements have been made with our billing office prior to you appointment. We gladly accept cash, debit cards, VISA, MC, DISC, AMEX. Please no checks.

Lab Results

Annual Physicals and other routine visits may involve labs that our providers will recommend to help diagnose your symptoms, monitor chronic disease and medication management, or screen for disease prevention.  Most routine labs are done right here at PV Family Care.  Please allow at least 72 hours before requesting your results.  In some cases, certain special labs will be sent out to outside testing facilities which may take up to two weeks.  You will find a Patient Contact form in our Patient Information section to fill out and update the best contact number to reach you so that we may relay your lab results. 

Prescription Refills

Please have your pharmacy fax a refill request at least one week before you run out of your medications.  If you are on long-term medication for chronic diseases you might be requested to make a follow up appointment prior to refilling your medications.  It is highly encouraged that you are evaluated by one of our providers every 3 to 6 months (depending on control of your condition) so that you have the best overall outcome, care, and disease management. 

SPecial form requests

Forms that are requested to be filled out by one of our providers will involve a flat rate administration fee. Common forms include wellness/school/sports physical forms, DOT forms, assisted living/home healthcare forms, Nursing School/EMT forms, Jury Duty excuse letters, and others. Please call our office at 602-482-6100 for questions about your request.