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.

Patient Registration Form
Registration Addendum

Patient Registration Form-Spanish
Registration Addendum-Spanish

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.

Medical Records Electronic Self Request
Medical Records Form
Medical Record Amendment Request Form