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Arizona Patient Forms

Please fill out only if requested.

Additional New Patient Forms:

  • Professional Disclosure
  • HIPAA Notice of Privacy Practices and Acknowledgment of Receipt
  • Consent to Treat
  • Telehealth Informed Consent
  • Consent to Receive Emails & Text Messages
  • Consent to Obtain Medication History
  • Acknowledgment of Financial Responsibility
  • Authorization for Disclosure of Minor Health Info to Parent-Guardian
  • Disclosure Authorization Form Primary Care
  • Disclosure Authorization Form – Other Providers
  • Credit Card Authorization
  • Consent to Medications
  • Patient Health Screen Child
  • Patient Health Screen Adult
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If you are having a psychiatric or medical emergency, please call 911 or go to the nearest emergency room. You can also reach the National Suicide Prevention Lifeline at 800-273-8255 or contact the Crisis Text Line by texting HOME to 741741.

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