Downloads

United MMC has provided you with these downloadable documents for your convenience. Below you will find Clinic Forms as well as Arizona Department of Health forms. If you have any questions, please do not hesitate to contact us at 602-955-1444 or email at info@unitedmmc.org

DOWNLOADS

 NEW PATIENT INTAKE FORM

CHRONIC PAIN SUPPLEMENTAL FORM

MEDICAL RECORDS RELEASE

UNITED FACT SHEET AND PRIVACY POLICY

PATIENT_ATTESTATION_FORM

PARENT-GUARDIAN_ATTESTATION_FORM

CAREGIVER_ATTESTATION_FORM

ADD_OR_REPLACE_CAREGIVER_FORM

DISPENSARY-AGENT-MEMBER-ATTESTATION-FORM