New Patient Forms

a doctor reviewing forms with a patient at Implant and Periodontal Wellness Center of Arizona

The following form is provided to our patients through our secure, Online Portal for your convenience. Please click on the button bellow to complete your patient information prior to your appointment.

New Patient Information

If you have questions about any of the paperwork, please give us a call at (480) 504-0506 and our staff will be happy to help you.

Please download, print and complete these additional forms, and bring them to your appointment:

•	Medical History
•	Assignment of Benefits
•	Consent for Use and Disclosure of Health Information
•	List of Accepted Insurances
•	Notice of Privacy Practices
•	Privacy Practices Acknowledgement
•	Protecting Our Patients
•	Coronavirus Statement
•	Medical History Addendum Covid

Pre- and Post Operative instructions

•	Non-sedation Surgery Pre Operative Instructions
•	Sedation Pre Operative Instructions
•	Perioscopy Instructions
•	Gingival Graft Post Operative Instructions

Office Hours

Monday	8–5
Tuesday	8–5
Wednesday	7–4
Thursday	8–5
Friday	8–12

Closed for Lunch	12–1

Contact Us

4455 E. Camelback Road
Suite #E-100
Phoenix, AZ 85018

(480) 504-0506

Implant and Periodontal Wellness Center of Arizona, 4455 E. Camelback Rd #E-100, Phoenix, AZ 85018 : (480) 504-0506 : azimplantsolutions.com : 6/8/2023 : Tags: Periodontist Phoenix AZ :