© 2018 by Agave Family Physicians 

  • Facebook Social Icon

21300 North John Wayne Parkway Suite 123, Maricopa, AZ 85139

Tel: 520-494-7778

Connect With Us on Facebook

Clinic Hours:
Mon-Fri: 7:30AM-5:00PM

Hours of Operation

Patient Forms

Office Forms

Privacy Notice

This form describes how we manage your private information.

Policies and Procedures

This form describes our office's general policies and procedures.

Financial Policy

This form describes our financial policies and patient responsibilities. 

Consent to Release Information

Use this form to provide us with the information about the ways we may contact you. 

Records Release

Use this form to request records to obtain records from or request records from another physician or hospital. 

Patient Registration Form

Use this form to register as a new patient or when you have a change in your insurance. 

Medical History Form - Adult

Use this form to provide us with your complete medical information.

Medical History Form - Child

Use this form to provide us with your child's (age 0-13) complete medical information.

**If you are registering as a new patient you will need to complete the Policies and Procedures, Financial Policy, Consent to Release Information, Patient Registration, and Medical History forms. If you would like us to have records from your previous primary care provider or a specialist, please also complete the Records Release form.  Even if these forms are complete we still require that all new patients arrive 30 minutes before your scheduled appointment time for processing. 

Other Forms