Check-in to Abrazo Surprise Hospital

Email Address *

We need your email address to send you the details of your visit. This email also includes cancellation instructions. No spam, we promise.

Patient's First Name * (Legal Name)

Middle Initial

Patient's Last Name *

Date of Birth *

Phone Number *

Gender *

Male
Female

Is the patient pregnant? *

Yes
No

Weeks pregnant *

Zip Code*

Contact Name (if different from patient)

Terms and Conditions

I have read and agree to the InQuicker Online Scheduling terms of use. *
I have read the when to call 911 guide and understand that Online Scheduling is not to be used for life-threatening, debilitating, or emergent medical conditions. I have determined my condition is not life-threatening and I can wait until I arrive for evaluation and treatment. *
I agree to receive health related information from the health system.

All patients will receive a Medical Screening Exam regardless of their ability to pay. If, from the Medical Screening Exam, it is determined that your condition is not a medical emergency, you may be asked to pay your co-payment or other financial obligation before receiving treatment. In the event that patients with more emergent medical conditions present to the hospital at your projected time to see a health care professional, those patients will receive treatment prior to you.

Visit Information

Patient Information