Patient Forms

Office and Patient Information

Hospital Affiliations

Our office currently utilizes hospitalists at various facilities for inpatient care.

Your First Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

  • Patient's insurance card
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient's medical and surgical history
  • Recent test results, x-rays, or relevant records
  • Be sure to have read our office policies
  • The patient forms below

Patient Forms

For your convenience, Pineapple Health is pleased to provide these fillable PDF patient forms for you to download prior to your appointment. Using your computer, please complete them, save them, and print out a copy to bring to your appointment. Please do not e-mail them to us, since e-mail is unsuitable for secure communications. Alternatively, we strongly recommend you to utilize our secure online forms provided below instead.

Online Forms:

Please fill out the form online and print your completed copy. Send any questions to [email protected]

Insurance and Payment Information

Currently contracted major insurance carriers:

  • BCBS
  • ACN
  • PHCS (only certain networks)

You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us at (480) 961-2366. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Please reference our Financial Policies form for detail.

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.

Notice of Privacy Practices

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