Please do not use this form if you have an urgent medical problem, need to reschedule an existing appointment, or are a current patient wishing to schedule a new appointment. Instead, existing patients may use our Patient Portal to request a new appointment or contact our office at (623) 349-1711 for further assistance. After you submit your new patient appointment request below, our appointment scheduler will respond within 48 hours. See below for forms to complete.
Patient Registration Forms
Balanced Mental Health of Arizona welcomes you to our practice. Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process.
Please be sure to bring all forms with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by another physician or provider.
Downloadable Forms:
Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
