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Patient

Welcome to AZPMRPC

Everything You Need for Your First Visit

Prepare for your appointment, complete your forms, and learn what to expect before arriving at our Chandler clinic.

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Please arrive 15 minutes early and bring your photo ID, insurance card, medication list, and referral if required.
Online Patient Intake

Complete Your New Patient Forms Online

Complete each section, review your information, and submit it before your appointment.

1
Patient Details
2
Medical History
3
Social History
4
Family History
5
Review & Sign

Patient Details

Contact Information

Medical History

Hypertension
Cancer
Stroke
Thyroid Problems
Asthma
Heart Condition / Disease
HIV
High Cholesterol
Diabetes
Arthritis
Joint Replacement
Seizures
Pacemaker / Defibrillator
Allergies

History of Surgeries

History of Hospitalizations

Social & Personal History

Family History

Review & Sign

Patient Signature

What to Bring

  • Photo identification
  • Insurance card
  • Medication list
  • Referral or authorization
  • Relevant medical records

What to Expect

1
Check In Our friendly front desk team will welcome you, verify your information, and help you get settled.
2
Medical Evaluation You will meet with your provider to discuss your health history, symptoms, and goals.
3
Personalized Care Plan We'll create a treatment plan tailored to your needs and answer any questions you may have.

Already a Patient?

Access follow-up paperwork or request your next appointment.

Questions Before Your Visit?

Our team is ready to help you prepare for your appointment.

Contact Our Office
Already a Patient?

If you are new patient please click on “New Patient” button to fill new form