Forms

If you are a new patient, please complete the forms on this page and email to us prior to your appointment at Info@sbhcarizona.com or bring to your initial appointment.

New Patient Forms

Demographic Form

New Patient Demographic Form

with your basic information

Download

Release of Information

Optional Form

Please complete if you would like to name a designated person or entity as an authorized person we can speak to regarding your treatment, medical records, and care

You may restrict certain information

Download

Consent to Treat-Notice of Privacy Practices-Financial Agreement

Required for all new patients to complete

This form includes consent to provide you services, review of our policies regarding HIPAA, confidentiality, privacy practices, payments and pricing

Download

Request for Records

Please fill out this form if you would like your complete medical records sent to yourself or a designated entity/person

An active Release of Information must also be completed along with this request

Download

Forms

Please complete prior to your first appointment

You may email your completed forms to Info@sbhcarizona.com or bring with you to your initial appointment

For telemedicine or telephonic visits, please email your completed forms to info@sbhcarizona.com