REGISTRATION FORMS: 

Please click on the links below to download our new patient registration forms.  Complete and bring to your primary care doctors office with your first visit.

REGISTRATION FORM 

MEDICAL REQUEST FORM

WELLNESS FORM    

SENIOR WELLNESS FORM

CELLULAR DEVICE OPT-IN FORM

Or, use the online forms below to complete, submit and print your own copies.  Be sure to complete all 4 otherwise you will have to finish once at the office.

Patient Registration Form                                  

Emergency Contact Form

Medical History                               

Authorization to Disclose Information & Office Policy

ONLINE BOOKING: 

To book an appointment online with your family doctor please click the box below.

MAKE AN APPOINTMENT: 

You can always make an appointment with your PCP by calling the office at:  

623-815-2900

Monday -  Friday     8:00 am - 5:00 pm
Saturday                   Closed
Sunday                      Closed

14973 W. Bell Rd., Suite 100, Surprise, AZ 85374

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(o) 623-815-2900  (f) 623-583-1319

Surprise Health Center