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    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 FormMild (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.
    1.   AHCCCS Checklist
     
     
     
     
     
     
  •  CAREcenterlogo

    Address

    Phone

     Center Hours

    Email

    777 E. Galveston St.

    Chandler, AZ 85225

    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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