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:
- Start by clicking the link “register online now” or Suboxone Inductions Forms
- You will be lead to a new page that shows our complete registration packet.
- 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.
- Now that you have completed the form you must download it to your computer (or print it)
- You will need to sign the completed form and then return it to Cholla Medical Group
- Be sure to include copies of your drivers license and insurance cards (front and back)
- Return forms via:
- Fax: 1-866-246-5494
- 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.