Patient Forms

Welcome to our practice

Here you will find forms for new patients to the practice along with existing patients that are coming in for their annual wellness visits or annual exams.

If you need to cancel or change your appointment, please give us the courtesy of 24 hours notice at least. We allow a significant amount of time for each patient visit which go unused in the event of a last minute cancellation. Therefore, $50.00 is charged for failure to cancel within 24 hours.

Please contact our billing department with any insurance or billing questions. 623.594.8417

NEW PATIENT PACKAGE - Please bring an ID with you and your insurance card along with the package. It is our practice policy that you bring ALL medications BOTTLES except for controlled substance medications with you for each office visit. This ensures your safety and accuracy.

ANNUAL EXAM PATIENT - This form is for all 16-64 to fill out for their annual physical exams. (MANDATORY YEARLY)

ANNUAL EXAM PATIENT - This form is for all 65+ to fill out for their annual wellness visit. (MANDATORY YEARLY)

Bestcare Internal Medicine

13945 W. Grand Avenue, Ste. A-105

Surprise, AZ 85374

Phone: 623.546.0007

Fax: 623.584.6915

Billing: 623.594.8417

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