Internal Medicine
New Patient Registration Forms
5950 S. Cooper Rd, Ste 4
Chandler, AZ 85249
Medical Records Released To You
Medical Record Release To CPC
Please complete this form and bring this to your appointment if you want us to
get medical records from your other providers.
Please bring both of the completed forms, and attach any other relevant
medical information and medication list.
Please bring your insurance cards and photo ID too.
We will have you sign insurance authorization and financial policy forms in our
office electronically.
Please read our HIPAA privacy policy rules and keep a copy for your records.
Do not need to bring this with you.
We will have you sign an acknowledgement of receipt of the privacy notice in
our office.
Medical Release Forms
Please complete this form and fax this to 480-895-3731 OR drop this off at
our office, only if you need copy of your records for yourself.
There is a Medical records copying fee that need to be paid to Chandler
Primary Care.
Please allow 3-7 business days to process the request.
LabCorp Results:
Obtaining your lab test results:
Please follow the instructions below to get results directly sent to
Sonora Quest
Sonora Quest
Demographic Information
Medical History