Patient Forms

Privacy Practices – English

Privacy Practices – Spanish


Please download and complete all forms in the Patient Forms Package.

Patient Forms Packet

Medical Records Release Forms (Optional)

Medical Records Release

Consents/Acknowledgements Signature Forms

Consents/Acknowledgements Form


Patient Referral Form

Please Note: If you are a referring physician and would like to have access to the online referral forms, please contact us for the access code

Patient Referral Form

Locations

Glendale Office

6677 W. Thunderbird,
Building F, Suite 101,
Glendale, AZ 85306
Phone Icon
623-878-3939
location

Scottsdale Office

10603 North Hayden Road,
Building H, Suite 100,
Scottsdale, AZ 85260
Phone Icon
480-664-4977
LOCATION

Spectra Eye Institute

15401 N 29th Ave,
Suite 201,
Phoenix, AZ 85053
Phone Icon
623-583-2020
LOCATION

Scottsdale Eye Surgery Center

8414 N90th St.
Scottsdale, AZ 85258
Phone Icon
480-949-1208
LOCATION

Buckeye Surgery Center

23390 W Yuma Rd. #106
Buckeye, AZ 85326
Phone Icon
623-250-4800
LOCATION
Eye Physicians & Surgeons of Arizona