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  • Meet Our Providers
    • David J.Mickus, M.D. / Samantha Hoover, PA-C
    • Tracey L.Martin, M.D.
    • Sufia H. Khan, M.D.
    • Regina M. Wright, M.D.
    • Nabil N.Khouri, M.D.
    • Geolene Schaller, PA-C
    • Kali Delzompo, PA-C
  • Preventive Care
  • Urgent Same Day Care
  • Chronic Care Management
  • In-Office Procedures & Testing
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Patient Forms


Chronic Care Management - Tempe, AZ

The staff of East Valley Primary Care Physicians in Tempe, Arizona looks forward to having you join our host of satisfied patients. To schedule an appointment, please call us at (480) 820-1133.

Once you have scheduled your appointment, you can pre-register by downloading the forms below and bringing them with you to your visit. Completing the forms prior to your visit will help to speed up the new patient registration process.

Download new patient forms:

  • New Patient Package
  • Medical Release Form

Please note: It may take a few minutes to load the forms if you are using a dial-up Internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat Reader for free by clicking on the icon below.


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Disclaimer: If you register, make an appointment or submit any other information online, all your information is transmitted securely and is held in strictest confidence, adhering to HIPAA guidelines and protecting your privacy.

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The physicians at East Valley Primary Care Physicians offer Women's Health, Men's Health, gynecology, menopause, STD screening and management, prostate screening, immunizations, sport physicals, and asthma management. Our office is conveniently located in Tempe AZ, where we offer urgent care same-day appointments, onsite procedures & testing, and chronic care management.

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