Chandler CARE Center / Forms

Chandler CARE Center Forms

The forms below are available for your convenience. Most forms can be completed on your computer (unless noted) and printed out.

Sports Physicals
Print out the form below, complete in black ink and bring with you to the CARE Center.
1.	2017-2018 AIA Sports Physical Form (This form must be printed out, then completed by student and parent/guardian prior to the appointment.)
2. Mild Traumatic Brain Injury/Concussion Form Mild (Print and Complete)

Adult ONLY Immunization Forms - English
Print out the form below, complete in black ink and bring with you to the CARE Center.
1.	Adult Immunization Forms (This form must be printed out, then completed with a pen.)
2.	Adult FLU vaccine ONLY (This for must be printed out, then completed with a pen.)

Child Immunization Forms - English
Print out the form below, complete in black ink and turn in on the day of your appointment.
1.	Immunization Clinic Forms (This form must be printed out, then completed with a pen.)
2.	Child FLU vaccine ONLY (This form must be printed out, then completed with a pen.)

Chiropractic Forms - English
You may complete the forms below on the computer, print out and turn them in on the day of your appointment or print out the forms, complete with a black pen and turn the forms in on the day of your appointment.
1.	Intake Form
2.	Chiropractic Form (This form must be printed out, then completed with a pen.)
3.	Parent/Legal Guardian Consent for Treatment of a Minor

Dental Forms - English
You may complete the forms below on the computer, print out and turn them in on the day of your appointment or print out the forms, complete with a black pen and turn the forms in on the day of your appointment.
1.	Intake Form
2.	Medical History Form
3.	Parent/Legal Guardian Consent for Treatment of a Minor

TB Skin Test Forms - English
You may complete the forms below on the computer, print out and turn them in on the day of your appointment or print out the forms, complete with a black pen and turn the forms in on the day of your appointment.
1.	Intake Form
2.	TB Skin Test Forms
3.	TB Skin Test Funding Notice

All Medical Appointment Forms - English
You may complete the forms below on the computer, print out and turn them in on the day of your appointment or print out the forms, complete with a black pen and turn the forms in on the day of your appointment.
1.	Intake Form
2.	Medical History Form

Southwest Behavioral Referral Form - English
You may complete the form below on the computer, print out and turn it in on the day of your appointment or print out the forms, complete with a black pen and turn the form in on the day of your appointment.
1.	Southwest Behavioral Form

Vision & Hearing Forms - English
You may complete the forms below on the computer, print out and turn them in on the day of your appointment or print out the forms, complete with a black pen and turn the forms in on the day of your appointment.
1.	Vision and Hearing Visit (Minor) Form

Requirements for AHCCCS - English

The document below will assist you in determing what items you will need to bring in with you.


Address	Phone	Center Hours	Email
777 E. Galveston St. Chandler, AZ 85225 Map View	480-812-7900	Monday - Thursday 7:30 a.m. - 4:30 p.m. Friday 7:30 a.m. - 3:30 p.m.	chandlercarecenter@cusd80.com
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Chandler CARE Center