Family Doctors of Green Valley would like to offer our patients the convenience of filling out Patient Forms before you come in for your appointment. This will decrease your waiting time at your appointment.

Please fill out all seven pages of either the Insured Patient Forms or Self Pay Patient Forms. Please make sure to fill out the Consent to Treat a Minor Child Form under General forms, if a child under the age of 18 will be seeing a doctor. Once the forms are filled out completely, please fax all pages to (702) 616-9681. Make sure to bring the original copies to your appointment.

Insured Patient Forms

• Patient Information
• Financial Policy
• Release of Information
• Patient Consent for Use and Disclosure of Protected Health Information (PHI)
• HIPAA Consent Form
• Acknowledgement of Receipt of Office Policies
• Office Policy Acknowledgement
• Lab Draw Consent

Self Pay Patient Forms

• Patient Information (Self Pay)
• Financial Policy (Self Pay)
• Release of Information
• Patient Consent for Use and Disclosure of Protected Health Information (PHI)
• HIPAA Consent Form
• Acknowledgement of Receipt of Office Policies
• Office Policy Acknowledgement
• Lab Draw Consent

General Forms

• Consent to Treat a Minor Child
• Notice of Privacy Practices