Dr. Hajbandeh
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New Patient Forms

1) Fill out all five pages of forms.  OK to download them and fill them out electronically.  Be sure to SIGN when needed.
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2) Either PRINT and bring the completed forms with you to your appointment, or SAVE and EMAIL them to our office before your appointment.  You may email them to: [email protected] with the subject line of "NEW PATIENT PAPERWORK."  (Please note that we do NOT use an encrypted email account.  If you choose to email your forms, you accept the risk of sending an unencrypted email.)

**NOTE: If we do not have your COMPLETED forms in our office prior to your appointment time, your appointment may be RESCHEDULED!  Please plan to arrive at our office 15 minutes BEFORE your scheduled appointment time to make sure your paperwork is in order.  Thank you!

_new_patient_forms-merged_5_pages.pdf
File Size: 383 kb
File Type: pdf
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NEW PATIENT PAPERWORK

We would love to have you
​visit us soon!

Hours
M-F: 7:30 a.m. - 4:00 p.m.
Lunch 12-1 pm

Contact
Ph: 480-722-2595
Fax: 480-722-2599

  • Home
  • Providers
  • Services
  • Contact Us
  • Patients
  • how we bill