Forms 1, 2, 3, 4, 5a are required to establish as a patient in our practice.
If you wish to become a patient, we request you print out/download the forms and fill them out prior to your appointment.
Note: All patients, we have an Annual Administrative Fee of $60 (if age 25 and older) or $30 (if age 24 or younger) - see form below for questions concerning this - it is required yearly starting at your first appointment to establish in the office.
Note: we only accept cash or credit/debit cards (Visa, Master Card, American Express and Discover) - we do not accept checks
* Required at time of 1st visit This supplies the doctor with pertinent medical history.
Please fill it all out. We generally are unable to obtain any accurate previous records and so we truly count on you filling this form out. If you have prior records your think we need - please bring them with you to the first appointment.
* Required at time of 1st visit (We need form 5a signed and returned, not 5b) This form is require by state or federal agencies to acknowledge we provided you with our Notice of Privacy Practices (form 5b)
Important disclaimer: The information on this site, including on www.nsmedicine.com is provided as a supportive service to North Scottsdale Internal Medicine and Mark J Lewis, MD, PLC and is not meant to replace the advice of the physician who cares for you. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.
