FORMS PAGE

INTAKE FORMS

The below listed forms are available in various formats. The forms that say online can be completed and submitted online. The .pdf and .docx files must be downloaded, completed, and submitted via email or fax.

INTAKE / FACE SHEET - Google Forms (online)

INTAKE FORM - FACE SHEET (Google Form) - online form (English)

INTAKE FORM - FACE SHEET (Google Form) - online form (Spanish)

INTAKE FORM - FACE SHEET (Google Form) - online form (French)

Intake Form

TreatmentCenterPacket (English) (pdf)

Download

TreatmentCenterPacket (Spanish) (pdf)

Download

TreatmentCenterPacket-Hazael Health Group (French) (pdf)

Download

Applications form

please download and fill out the application/ Taxes Form: W-4, W-9, A-4 and submit via email. Email: hazaelhealthgroup@yahoo.com

Hazael Health Group Application (pdf)

W-4 (pdf)

W-9 (pdf)

A-4 (pdf)

Hazael Health Group

General Medical and Healthcare Clinic

Telemedicine Apps Download Page

Patient Portal Login

Forms Download Page

Address: 9005 N. 29th Ave. Ste 1 ,2 & 3, Phoenix, AZ 85051

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