Forms & Policies
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New Patient Packet (PDF)
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Patient Registration Form (PDF)
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Consent/Test Authorization (PDF)
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Billing Ledger Release (PDF)
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Release of Record (PDF)
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HIPAA Authorization and Release Form (PDF)
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Web and Social Media Authorization Form (PDF)
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Web and Social Media Release-Where the Garden Grows (PDF)
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Patient Packet -18yrs and older (PDF)
You can download the following forms and fill them out on your computer to print and bring in to your visit. If you prefer to use pen, please use black ink pen only – no gel pens
Printable Office Forms
Prior to your appointment, the forms listed below can be printed for your convenience. Filling them out beforehand will save you time by not having to complete them during your appointment. If you elect not to fill out these forms ahead of time, please arrive 15 minutes prior to your scheduled time. (You may download Adobe Reader for free at www.adobe.com.)
Great Destination Pediatrics
7757 W Deer Valley Rd Ste 275
Peoria, AZ 85382
Phone: 623-878-2800
Fax: 623-878-9150
Our Location
Quick Links
Office Hours
Monday - Thursday
7:30 am - 4:30 pm
Friday:
7:30 am - 12:00 pm
Closed Weekends
After Hours
After Hours appointments are offered Monday through Thursday
Call us at 623-878-2800 to schedule
Great Destination Pediatrics
7757 W Deer Valley Rd Ste 275
Peoria, AZ 85382
Phone: 623-878-2800
Fax: 623-878-9150
Our Location
Great Destination Pediatrics
7757 W Deer Valley Rd Ste 275
Peoria, AZ 85382
Phone: 623-878-2800
Fax: 623-878-9150
Our Location
Quick Links
Office Hours
Monday - Thursday
7:30 am - 4:30 pm
Friday:
7:30 am - 12:00 pm
Closed Weekends
After Hours
After Hours appointments are offered Monday through Thursday
Call us at 623-878-2800 to schedule