Patient Forms

Acrobat Reader icon Download Adobe Acrobat Reader to view, download, and complete each form.

Please complete these patient information forms and submit them prior to your visit. After downloading the forms, you may either fill them out on your computer or print them out and complete them by hand. If you would like to submit them by email, please send them to [email protected] as an attachment.

Thank you very much. We look forward to meeting you.

Patient Registration Form

Patient Medical History Form

Acknowledgement Form

Notice of Privacy Practices Form

Completed Patient Forms can be uploaded here:

(480) 661-6197
10210 N. 92nd Street, Suite 203
Scottsdale, AZ 85258
Due to Covid-19 now is a good time to schedule an in-office or virtual consultation with Dr Lille. Dr. Lille ulitlizes Zoom to connect with out of town patients and to plan surgeries now when you may have time in your schedule.


Request a Consultation

I would like an Online Consultation with Dr. Lille
I agree to the Terms of Use

90% of Our New Patients are Referred by Other Happy Patients!