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Forms
Patient
Registration
For your convenience, we
have provided our patient registration form below. Please print this form,
fill it out completely, sign, and date. When completed please return to
your Arizona Community physicians provider’s office either in person, mail
or fax.
Medical Records
For your convenience, we have provided our medical record request form
below. Requests for copies of your medical record must be made in writing
and must be hand-delivered in person, mailed or faxed to your physician’s
office. Before sending the form please make sure your selection is
complete, signed and dated.
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