New Patient Paperwork

Premier Medical Integration offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.
  • New Patient Health History Form

    Click to Download

  • Entrance Application

    Click to Download

  • Cancellation/No-Show Policy

    Click to Download

  • Consent for Purposes of Treatment

    Click to Download

  • Fit Life Questionnaire

    Click to Download

  • Notice of Privacy Practices

    Click to Download

  • HIPPA Declaration

    Click to Download

OFFICE HOURS


Monday
8:00am - 12:00pm
2:00pm - 6:00pm


Tuesday
8:00am - 12:00pm
2:00pm - 4:00pm


Wednesday
8:00am - 12:00pm
2:00pm - 6:00pm


Thursday
8:00am - 12:00pm
2:00pm - 4:00pm


Friday
7:00am - 12:00pm


Saturday
Closed


Chronic Pain Phoenix AZ Premier Medical Integration

Premier Medical Integration

11030 North Tatum Boulevard Suite 102A
Phoenix, AZ 85028

(602) 494-3037