Send Records to Flow Heart & Vascular

Flow Heart & Vascular

Send what you have; fill in only the gaps.

Upload existing records or medication lists instead of rewriting them.

New patients: Complete the registration and consent/signature sections of the intake packet. Paper copies are welcome. Call 480-571-1863 for help.

First name

Last name

Date of birth

Use the patient’s date of birth so we can match these records correctly.

Email address

Optional. We can contact you by phone.

Phone number

What are you sending information for?

My upcoming visit or first visit Request a written records review An update for my Flow care team I need the office to request records for me

Anything missing or changed?

Optional. Tell us your main question, medication or allergy changes, or details missing from your records. Skip anything already uploaded.

Completed forms, records, or medication files Upload signed forms, relevant records, or medication lists/photos. Up to 20 files and 75 MB total. For additional submissions, use the same patient name and date of birth and label them “Part 1 of 2,” “Part 2 of 2.” Call 480-571-1863 for large files or full imaging studies.

Add file

Please upload a file

Where are your prior records? Optional. Use existing records instead of rewriting your history.

I am uploading records Please request records for me My records were already sent to Flow I do not have records or am not sure

Other doctors or hospitals with records

Optional. List other doctors or hospital visits, with city and approximate dates. Skip details already uploaded or listed on your authorization.

Authorize us to request records

Sign your records authorization securely

Opens in a new tab. Enter your email to receive a private signing link. Use the same patient name and date of birth; list prior providers only once.

Prefer paper? Download the release, sign it, and upload it here or bring it to the office.

The authorization is separate. Return to this form and choose Send securely to submit your other information. Call 480-571-1863 for help.

Insurance card photos — front and back Optional for a visit or changed insurance. Add both sides of each card instead of copying policy details. On a phone, tap Add file to choose photos or the camera, if offered. You may bring your card instead.

Add file

Please upload a file

Photo ID — front only, optional Optional. Upload the front of your current photo ID, or bring it to your visit. Skip if the office already has it.

Add file

Please upload a file

Current primary care doctor

Optional. Enter your doctor’s name and practice, if known. You may write “none” or “not sure.”

Recent testing relevant to your visit or records review Optional. Have you had recent heart or vascular testing, or blood work related to your current concern? Select all places where it was done. Please skip unrelated scans. Mention older tests only if they relate to this question or our office requested them.

SimonMed

Arizona Diagnostic Radiology

Labcorp

Sonora Quest

HonorHealth

Another facility

Not sure

Test, location, or approximate date

Optional. Add the test, facility location, and approximate date. For “Another facility,” include its name. Skip details already uploaded or on your authorization.

Before you send

Please do not include Social Security numbers or payment-card details. Sending information does not schedule an appointment or book a paid records review. Our office will confirm the service and fee separately.

Need help or prefer paper? Call 480-571-1863 for delivery instructions.

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