Cholla Medical New Patient Registration
New Patient registration for group home care or assisted living facilities.

 

 

New Patient Registration

New Patients Must Fill Out The New Patient Registration Forms:

Our registration forms are available for download online, or you can send us a contact request and we will email/ direct mail our new patient registration forms.

To fill out your forms online:

  1. Start by clicking the link “register online now” or Suboxone Inductions Forms
  2. You will be lead to a new page that shows our complete registration packet.
  3. You can fill out the form online by clicking on any field you would like to type in. Enter your name and complete registration information.
  4. Now that you have completed the form you must download it to your computer (or print it)
  5. You will need to sign the completed form and then return it to Cholla Medical Group
  6. Be sure to include copies of your drivers license and insurance cards (front and back)
  7. Return forms via:
  • Fax: 1-866-246-5494
  • Email:Cmgstaff@chollamedical.com
  • Mail:10631 S. 51st Street, Suite 1 Phoenix, AZ 85044

Feel free to contact us for more information, questions, or help filling out the forms.