Please CLICK HERE to read about what COVID-19 precautions we are taking.

Patient Forms

You will need Adobe Acrobat in order to print/view forms. To Download Adobe Acrobat, please click here.

How to fill out the forms:

  1. Click on the pdf link below
  2. Fill out the form in your browser
  3. When you’re ready, click on the “Print” icon (top right corner).
    *Please do not click the “Download” icon. This method will not keep the filled out form.

Please print out the forms below and bring in to your first appointment at our Scottsdale and Phoenix, Arizona locations. Thank you and we are looking forward to seeing you soon.

New Patient Form

If you are a new patient, please click the icon to the left to print and fill out new patient forms to bring to your appointment.

Release Medical Records Form

If you would like the AZ Oculoplastic Specialists to obtain copies of your records from another provider, please fill out the following form and send or hand deliver to us.


Arizona Oculoplastic Specialists

9431 E. Ironwood Square Dr.
Scottsdale, AZ 85258

Phone: (480) 905-1010

Fax: (480) 905-6988

Office Hours

Monday: 8 am - 5 pm

Tuesday: 8 am - 5 pm

Wednesday: 8 am - 5 pm

Thursday: 8 am - 5 pm

Friday: 8 am - 4 pm

Saturday: Closed

Sunday: Closed