Patient Care Forms
New Patient Adult Forms
- New Patient – Adult [PDF]
- HIPAA Contacts [PDF]
Insurance and Payment Information
Office Policy and Procedures
- Patients should always bring a current insurance card and form of ID at every visit, not doing so may result in rescheduling your appointment.
- Patient will be responsible for any charges incurred not covered by insurance and he or she is solely responsible for checking on insurance eligibility for any service provided in the office, immunizations, medication treatment, test recommended or referral given.
- Messages are checked by 4PM every evening; please give us 48 working hours to respond to any non-urgent requests.
- Please have your pharmacy contact us regarding prescription refills; it may take 48 to 72 hrs to complete your request.
- Please use the after hours urgent line for emergency calls only, note that routine prescriptions, antibiotics or pain medications will not be filled after hours. If emergent care is needed we advise you to call 911 or seek care at the hospital ER. Please note that our office hours are Monday through Friday 8AM to 4PM and Saturday 9AM to 12PM, any messages left when the office is closed will be addressed after the next working day during office hours only.
- Please notify us at least 48 hours in advance if you need to cancel your appointment. We appreciate this courtesy; this allows us to accommodate other sick patients who might be in need of an appointment that day.
- We reserve the right to discharge any patient who repeatedly fails to show for their appointments. We strive to offer good medical care and expect good compliance from all our patients.
- We have an outside billing company that processes our claims, for any billing questions please contact their 1-800 number on your invoice.
- Please allow 7 to 10 days for lab and imaging reports to be received and reviewed. If your tests are abnormal you may be asked to come in to discuss the results with our provider. Contact us if you have not received a call regarding your tests two weeks after your test.
- HIPPA Policies [PDF]
Fountain Hills Pediatrics and Internal Medicine follows HIPPA guidelines for patient privacy.