Flagstaff Family Physicians, P.C -Robert Yee, M.D.

Available Forms

Alcohol Questionnaire- AUDIT -C *new patient form* Depression Health Questionnaire (PHQ-9) *new patient form* HIPAA *new patient form* Intake Questionnaire *new patient form* Medical Records Release *new patient form* Medicare Wellness Survey (Medicare Required) Patient Registration Form *new patient form* Payment Policy *new patient form* Physical Exam Form Required

Medical Records Release new patient form

Flagstaff Family Physicians, P.C.

Robert S. Yee, M.D.

Telephone Number 928-226-1454

Fax Number 928-226-1461

Medical Records Release

Please send/fax/use portal to provide all medical records to-Robert S. Yee,M.D. A.B.F.M. Board Certified 710 N. Beaver Street Building #3 Flagstaff, Arizona 86001

Electronic Signature *

Date *

Name and Address of Provider *

This is the name of provider you would like to get medical records from.

Telephone Number *

Fax Number *

* Required field