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StatClinix Urgent Care, 5 Arizona Locations
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Home › Services › Forms

Forms

In an effort to expedite your check-in STATCLINIX is pleased to offer our Registration forms for download. Complete these forms and bring them in with you to save valuable waiting time.

Patients need to complete the Patient Information Forms and Medical Treatment and Financial Agreement on their first visit and annually thereafter.

STATCLINIX registration forms  are available below.  Note that all forms require the use of Adobe Acrobat Reader. You can download the Adobe Reader for FREE in case you don’t already have it.

General Forms

  • Patient Information Form
  • Medical Treatment and Financial Agreement
  • Notice of Privacy Practices

StatClub Form

If you will be joining our Medical Discount Program, please complete the StatClub Enrollment Form in addition to the forms above.

  • StatClub Enrollment Form
  • Fountain Hills
  • Mesa (Gilbert & Brown)
  • Payson
  • Scottsdale
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