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Patient Forms

Want less stress while waiting for your visit?? Download our patient forms!! You can fill them out in the comfort of your own home and bring them with you to your appointment.


Patient Demographic Form 
This form assists us in capturing all of your contact information including demographic, insurance, pharmacy, primary care, referring physician and emergency contact information. Please print out, sign in BLUE OR BLACK INK and bring with you to your appointment! + Download


Patient - All Consent Form 
This form includes your signature for our Privacy, Release of Medical Information and Assignment of Benefits policies. Please print out, sign in BLUE OR BLACK INK and bring with you to your appointment! + Download


Patient Medical History Form
This is our medical history form which helps our physicians best assess your needs. Please complete THOROUGHLY using BLUE OR BLACK INK and bring with you to your appointment. + Download


Notice of Patient Privacy Practices
Please read our Patient Privacy Policy. You do not have to bring this form to the office. We ask that you acknowledge acceptance of this policy on the Patient Consent signature form. + Download


Consent for Release of Medical Records to EVC
This form is used to provide consent for East Valley Cardiology to request medical records from an outside doctor or facility for our Physician on your behalf. Please Print/Sign and complete the form in BLUE or BLACK INK. Forms can be brought in at appointment time, mailed or faxed. Please Attention all requests to the Medical Records Department. + Download


Authorization to Release Records From EVC
This form is used to authorize East Valley Cardiology to release medical records to a person, physician or other entity specified by you. Please Print/Sign and complete the form in BLUE or BLACK INK. Forms can be brought in at appointment time, mailed or faxed. Please Attention all requests to the Medical Records Department. + Download


NOTE: All forms require Adobe Reader to view. Download Here.

Electronic Prescriptions
Help us better serve you with electronic transmission of your prescriptions directly to your pharmacy!!  When coming in to the office for your visit, bring along the name, address and, most importantly, PHONE NUMBER of your preferred pharmacy.

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