Patient Portal

Mon, Tues: 9am-6pm
Wed: 12pm-8pm
Thur, Fri: 8am-5pm
(480) 315-9757

Book an Appointment
Insurance Plans

"How Diabetes Works"

New Patient Forms

We know your time is valuable, so we have posted our new-patient forms online to fill out before you arrive at our office. There will be additional questions to answer upon arrival at our office, so if a new patient, please arrive at least 25 minutes prior to your appointment time. Existing patients should arrive at least 10 minutes prior to their scheduled appointment.

Just print and complete all relevant forms and bring them with you to the DiabeVita office. Please bring your photo ID and insurance card(s) as well if applicable. We’ll scan them into our electronic medical records system.

All forms below are in PDF format, which your computer should recognize. Click on each form name in blue to see the form on your screen. Some of the forms you can type in your information online before printing; others just print out and complete in dark ink.

Patient Registration, Policies, Insurance and Medical History Forms

These forms are required of all new patients. Here you’ll give us information on you and your family members, emergency contacts, and any insurance company you want us to work with. In addition, this is where you tell us about any allergies, existing physical conditions, current medicines, etc so we can better treat you for future optimum health. Also included are our privacy and financial policies, and an authorization to access your information via our online patient portal.

Medical Records Release and Authorization Forms

If you would like us to obtain a copy of your medical records from another doctor or hospital office, complete the first page of this file and send to that doctor’s office. Note there may be a small charge to you by that doctor’s office for retrieving your records, copying and then sending to us.

If you need a copy of your record from our office to give to another doctor, complete and submit the second page of this file to us and we can send your records by mail, through a secure electronic connection or provide you with a copy. There may be a small charge for our time. You can obtain parts of your medical record at no cost anytime from our secure and confidential Patient Portal.

If you want us to discuss your medical condition and healthcare needs with a third party - a friend, family member or other person - page 3 of this file will give us the authorization to do so.

Patient Portal Authorization Form

This form is part of the "new patient" form set above, but if you are an existing patient and are not yet using the convenient pateint portal, please complete this form so we can communicate with you online for routine administrative matters, share lab results with you and for your convenient access to your personal medical history at any time. See complete details on our Patient Portal to learn more about its many advantages.