New Patients

Print Intake Form

New Patients

Contact the Center for Advanced Spinal Surgery of Southern Arizona Today


Forms And Policies

Before your first visit, please fill out our Patient Intake Form and complete it in the comfort of your own home on your computer, tablet or smart phone.  This will make your visit much more relaxed.

Patient Intake Form

What Should You Bring To Your Appointment?

We want to answer all your questions at your visit. Please be sure to have the following with you:

  • Health Insurance Card/Information
  • A friend or family member to take notes/help with questions
  • A list of all medications you are taking
  • A list of your questions /concerns
  • A copy of your XRAYS’s/MRI’s/CT scans (not the reports – get the actual films)
  • Copies of records from doctors related to your visit with us
  • Patient Information Form
  • Patient registration Sheet
  • HIPAA acceptance
  • Release of Confidential Information


Please arrive early for your appointment if you do not have the forms completed.

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