Forms
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| Cottonwood Medical Center, Ltd. is dedicated to providing excellence in all areas of patient care, to foster the highest levels of academic and clinical development of its providers, and to provide strong leadership in the development, growth, and direction of health care in our community. |
These forms are available for you to download, print &
complete before your visit to expedite your
registration.
Child Registration & Health History: 3 Pages (100KB)
Adult Registration & Health History: 3 Pages (100KB)
These forms are available for you to request that
your medical records be sent to or from Cottonwood
Medical Center, LTD.
Request for records to be sent to Cottonwood Medical
Center,LTD. from another health care provider:
1 Page (16KB)
Request for records to be sent from Cottonwood Medical
Center, Ltd. to another health care provider:
1 Page (16KB)
Forms on this page require Adobe Acrobat Reader.
complete before your visit to expedite your
registration.
Child Registration & Health History: 3 Pages (100KB)
Adult Registration & Health History: 3 Pages (100KB)
These forms are available for you to request that
your medical records be sent to or from Cottonwood
Medical Center, LTD.
Request for records to be sent to Cottonwood Medical
Center,LTD. from another health care provider:
1 Page (16KB)
Request for records to be sent from Cottonwood Medical
Center, Ltd. to another health care provider:
1 Page (16KB)
Forms on this page require Adobe Acrobat Reader.
You may complete and submit new patient
information online through our secure server.
A pre-visit questionnaire and a pre-followup
questionnaire are also available for
established patients.
information online through our secure server.
A pre-visit questionnaire and a pre-followup
questionnaire are also available for
established patients.
| Cottonwood Medical Center, LTD. 560 N Camino Mercado, Suite 7 Casa Grande, Arizona 85122 Tel: (520) 836-5538 Fax: (520) 876-0878 Toll Free: (800) 895-5538 www.cottonwoodmedical.com |