Forms & Policies

Patient Forms

You may download and print patient registration forms used for new patients and change of information before coming to our office. Completing these forms prior to your visit will expedite patient registration. Please read and complete the forms below prior to our initial visit. Please feel free to contact me with any questions. This is a downloadable msword document.

COVID-19 Informed Consent Form

To download the consent form click here.

Patient Registration Form

To download the registration form click here.

If you are a returning patient and need to update your home address or insurance information you can do so by filling out a Patient Information Form. Bring it with you on your next visit and we will gladly update your records

 

 

 



Schedule an Appointment Phn:(928) 499-0760 Email: summersdj@q.com
115 S McCormick St Suite 2 Prescott, AZ 86303