

3333 East Camelback Road
Suite 175
Phoenix, Arizona 85018

phone 602-840-3120
fax 602-840-3237
Forms
Save time by downloading these forms at home.
When completed, please send them to:
medicalrecords@camelbackpeds.com
Patient Registration Packet
Completed forms can be sent ahead of scheduled appointment to medicalrecords@camelbackpeds.com
Telephone/Telemedicine Consent Form (NOTE: To sign digitally, you must open the document in a PDF application, complete, sign and email back to us. Optionally, you can print, complete, scan and return via email.)
Record Release Form
Consent to Release Information form (for patient's 18 or older)
Patient Behavioral Health Surveys
MChat
Vanderbilt Parent's
Vanderbilt Teacher's
PHQ-9 Modified for Teens
PHQ-9 Adult
SCARED Anxiety Screen - child to complete
SCARED Anxiety Screen - parents to complete
GAD-7 Anxiety Screen
Attention Deficit Disorder Initial Intake Questionaire
For the most up-to-date information on our accepted private health insurance plans
contact our clinic directly at 602-840-3120
