Pulmonary, Critical Care, and Sleep Medicine

Patient Information

Arizona Center Chest Diseases Patient Information

Prior to your first office visit to Arizona Center Chest Diseases, you will have opportunity to fill out several forms. Some of these forms provide demographic and insurance information. Other forms provide the physician with an overview of your symptoms and health history from which to initiate your office evaluation.

Alternatively, the forms will be provided upon arrival for your visit. We ask that you arrive at least 30 minutes prior to scheduled office visit to provide enough time to complete the forms and questionnaires if not completed ahead of scheduled visit. If forms are complete, please arrive 15 minutes prior to scheduled appointment time.

Patient Forms

Please take the time to fill out your forms before your visit, this will help your visit to go as smoothly as possible, include contact information for daytime phone numbers.

Click here to go to the Patient Forms Downloads page.


To submit forms online please submit through our patient portal. Please call 602.264.5685 to get started with a login to the patient portal.

Our ability to communicate with you is dependent upon a daytime contact number. Cell phone numbers are preferable.


PCP and referring doctor name

Most of our patients are referred to us from other physicians and medical offices. Therefore, it is very important that we maintain good communication with the referring physicians and primary care physicians. Please provide as much detailed information as possible for both the referring physician as well as your primary care physician.

Financial Policy

Please bring your insurance card and photo ID to each office visit. If your insurance changes, please notify our billing office immediately to confirm that our physicians are contracted with your insurance plan.
If your insurance requires a copayment for services, it will be collected prior to office visit. For your convenience, we accept cash, checks, and credit cards (MasterCard, VISA, and Discover). We do not bill secondary insurance for copay. If you do not make your copayment at the time of service, we reserve the right to assess a $25 surcharge to cover administrative costs to collect balance.

Scheduling and confirmation of appointments

We will call you to confirm your appointment 2 business days prior to your scheduled visit. If we are unable to contact you, we will leave a voice mail message. Please respond to voice mail and confirm your appointment by noon prior to the day of office visit to secure your appointment. If we do not have confirmation of appointment by noon on the day prior to scheduled appointment, then we may offer your appointment to the next person on the waiting list.
We require that you provide a cell phone or daytime phone number by which we can contact you for confirmation as well as any unexpected schedule changes.
We attempt to schedule all future follow up appointments at the time of check out from present office visit.

Schedule changes

Our office schedule and office physician availability is subject to change depending on our hospital coverage requirements. From time to time, it may be necessary to reschedule your visit. We recognize that this is an inconvenience and only requested as a last option. We appreciate your flexibility to accommodate any change.

If you are arriving late for your scheduled appointment

If you are arriving late for your visit for any reason, we appreciate notification when possible. We know that the unexpected happens and the delay may be outside of your control. We will make every effort to accommodate you as long as it does not cause further delay in other patient’s scheduled visit.

Cancellation policy

If you need to cancel or reschedule your appointment, a 48-hour notice is required. If you fail to keep your appointment without notification or last minute cancelation, a fee of $50 will be assed directly to you. We understand that schedule changes may be needed but we require sufficient notice so that we can provide service to other patients on the waiting list.

If you are calling for your doctor because you are sick or for other reasons

In the event that you need to speak with your doctor, please call the office and leave a message detailing which doctor you are calling for and brief description of details. If your message is of a nonurgent matter, your call will be returned by the end of office hours the same day.

After hours calls

If you need to speak with a doctor regarding an urgent matter after regular office hours, please call the main office number which will be routed to the our answering service. Please provide the necessary information, unblock your phone number, and the on call physician will be notified. The on call physician cannot always respond immediately but will provide as much assistance as possible over the phone.

Prescription Refills

If you are running out of medication and need a refill, please notify your pharmacy. If you have not been seen in the office within the time requested on your last office visit, you may be requested to return for follow up office visit prior to refill. Please allow at least 72 hour response time.

Test Results

We do not routinely call patients with test results. Follow up of test results are usually discussed in detail on next office visit. If an abnormal test requires more immediate attention, you will be notified with subsequent instructions.

Copy of medical records

We will provide a copy of your medical records upon request. Please allow 3-5 business days for us to copy records. A copying fee of $10 flat fee plus 10 cents per page will be issued for this service the fee is only if
assessed if a ” hard copy ” of medical records is given, not if the records are faxed to another provider.

Disability forms

Any forms requiring completion by the office physician with be assessed a $25 charge.

Medication lists

We request that you bring all current or active medications or bring an up to date list of your medication with every visit. An up to date and current list of medications is very important as patients frequently have more that one specialist involved in their care.

Chest X-rays, CT chest (CAT scans), and other imaging studies

New patients need and returning patients need to to hand carry any chest x ray or CT chest scan completed at another facility to their appointment. Dictated reports are helpful, but actual films or digital images are usually required.

Prior authorization for tests

Depending on your insurance plan, prior authorization for outpatient test may be required. This can be a time consuming process that delays care or possibly changes the plan of care. This is not something that we have direct control over. We will do our best to communicate any delay or changes imposed by the insurance plan.

Prior authorization for nonformulary medications

Depending on your pharmacy coverage, prior authorization for a specific prescription may be required. In this case, please allow 7-10 days to complete paperwork. Completion of paperwork may be delayed by insurance carrier response times.