Forms
Patient Forms
Resources and forms for new patients using select services with Arizona Liver Health are provided below. Follow
the instructions in the documents for completing and bringing the documents with you to your appointment.
NEW PATIENT PACKET
Please complete the new patient paperwork and bring it with you to your appointment to help us streamline your visit.
RECORDS RELEASE FORM
Complete the records release form to easily submit your request for medical records or share them with another provider.
HIPAA FORM
Please complete the HIPAA form prior to your appointment to ensure we can securely manage your health information.
HIE FORM
Resources and forms for new patients using select services with Arizona Liver Health are provided below. Follow the instructions in the documents for completing and bringing the documents with you to your appointment.
FREE FIBROSCAN FORM
Resources and forms for new patients using select services with Arizona Liver Health are provided below. Follow the instructions in the documents for completing and bringing the documents with you to your appointment.
What to Bring to Your Appointment
We’ve put together quick lists of documents to bring to your Arizona Liver Health appointments. This information
usually depends on the type of appointment and whether you’ve been to Arizona Liver Health before.
INITIAL CONSULTATION
If it’s your first time at AZ Liver and you’re visiting for a screening or consultation, please bring:
- Photo ID
- Proof of address, if different from your photo ID address.
- Your medical insurance card or other applicable information (optional)
- New Patient Information Packet:
- Patient Information Forms
- Privacy/HIPAA Acknowledgement Form
- Pharmacy contact information
TREATMENTS AND FOLLOW-UP VISITS
If you’re coming in for a follow-up visit, please bring:
- Photo ID
- Your medical insurance card or other applicable information