New Patient Forms & Intake Information

We look forward to welcoming your family to Pimri Pediatrics. Please review the information below before beginning the new patient intake process.

⚠️ New Patient Forms Temporarily Unavailable

The online new patient forms link is currently not working. Our team is working to resolve this issue. In the meantime, please call our office and we will help you begin the process.

📞 Call 480-485-5166

📋 Please Have This Information Ready

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Birthdates for all children.
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For newborns and infants: birth weight, length, and head circumference (if known).
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Names of all medications, supplements, and herbal treatments.
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Dates of procedures, surgeries, hospitalizations, broken bones, and other significant medical events.
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Insurance ID number and policy/group number if using insurance. Please include secondary insurance information if applicable.
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Pictures of the front and back of your insurance card. For newborns, please upload a parent's insurance card.
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A list of questions and concerns you would like addressed during your first visit. This helps us schedule enough time for your appointment.

⏰ Important: Complete Forms in One Sitting

The intake forms must be completed in one session. You may transfer certain information between children, such as address, phone number, and family medical history. However, once you begin, you will not be able to save your progress and return later.

Start Your New Patient Forms

Click the button below to begin your intake forms.

Begin New Patient Forms

Not Sure If Pimri Pediatrics Is The Right Fit?

If you are still deciding whether our approach is right for your family, please do not complete the intake forms yet. Instead, send us a message through our Contact Us page so our staff can answer your questions and discuss your concerns.