​Miscellaneous Forms - English

Paquete de paciente nuevo

​Para ahorrar tiempo durante su primera cita, complételos con anticipación y tráigalos con usted durante su cita.

For your convenience, we have included several forms on our website. They will open in a new window and they are in Adobe Acrobat PDF format.

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Lista De Medicatmentos

Traiga una lista completa de medicamentos para cada visita, incluidos TODOS los medicamentos recetados, medicamentos de venta libre, vitaminas, gotas para los ojos, cremas, suplementos herbales, parches, inhaladores, insulina, etc. Hemos proporcionado una lista de medicamentos que puede traiga a su próxima visita.

​​​​Formas Diverso - Espanol

Aviso de Privacidad

Este aviso describe cómo se puede usar y divulgar su información médica y cómo puede obtener acceso a esta información. Por favor revíselo cuidadosamente.

New Patient Package

To save time during your first appointment, please fill these out ahead of time and bring them with you during your appointment.

Blood Pressure Check

Has your doctor asked you to document your blood pressure? If so, print this document out and bring it to our office once you have filled it out.

Call Us:  (928) 329-8331

Medication List

​Please bring a complete list of medications to every visit including ALL prescription drugs, over-the-counter medications, vitamins, eye drops, creams, herbal supplements, patches, inhalers, insulin, etc. We have provided a medication list that you can bring to your next visit.

Referral Form For Consultation

If you are a provider please fill this form out and provide the necessary documents and have them faxed to the number located on the bottom of the form.

If you are self-referring yourself to Yuma Nephrology, fill this form out and provide the necessary documents and have them faxed to the number located on the bottom of the form or bring them to our office.

​Provider Forms

Forms

Notice of Privacy

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

​​​Yuma Nephrology, P.C.​

Registro de la Presión

¿Le ha pedido su médico que documente su presión arterial? Si es así, imprima este documento y tráigalo a nuestra oficina una vez que lo haya completado.