Patient Forms

New Patient Forms​ - All new patients should fill out these forms 

Medical Records Request Form - Fill these out if you would like our office to request medical records from another provider 

Depression Screening Form - Fill out this form if you are being seen for any mental health concerns or if your appointment is for a well exam

Adult ADHD Symptom Checklist

Consent to Treat Minor Without Parent or Legal Guardian Present

Consent to Release Information to Family or Friend

For Patients 18-21 Authorization to Release Medical Information to Family Members 

Prescription Refill Policy Acknowledgement


41810 N Venture Drive 

Suite E160

Anthem, AZ 85086

Fax        (623) 266-3053

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For Life-Threatening Emergencies Call 911

© 2018 Peak Medical & Wellness Center PLLC