New Patient Registration

Medical Records Fax Number: (520) 324-3300

Medical Records Email: CCRS-MR@childrensclinics.org

New Patient Forms and Info

Welcome to the Children’s Clinics! If you are a new patient, you’ll need to complete the following forms. You can fill them out here and send them to our scheduling staff, or you can print them and bring them with you. For questions about new patient registration, please call us at 520-324-KIDS.

New Patient Information Medical Consent to Treat

Send your completed forms back to the Children’c Clinics

Patient Name*
First Last
Email*
Upload your Completed "New Patient Information" Form
Accepted file types: pdf.
Upload your Completed "Medical Consent to Treat" Form
Accepted file types: pdf.

Employment • Financials • Contact• Make a Payment

Children's Clinics is a registered 501(c)(3) Charity © 2017
Site Created by Single Focus Web. Websites That Work For Nonprofits.