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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.
      
     
    Solo Adultos - Clinica de Vacunacion para Adultos  - Spanish
     
    1. Clinica de Vacunacion para Adultos (Por favor imprimir esta forma, llenela con pluma.)
    2.  Consentimiento Adulto para la Vacuna de Flu (Por favor imprimir esta forma, llenela con pluma.)
       
     
    Child Immunization Forms - Spanish
     

    1.

    Clinica de Vacunacion (Por favor imprimir esta forma, llenela con pluma.)

    2.

    Consentimiento para la Vacuna de FLU (Por favor imprimir esta forma, llenela con pluma.)
     
    Chiropractic Forms - Spanish
    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.

    Chiropractor Form

    3.

     
    Dental Forms - Spanish
    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.

     
    TB Skin Test Forms - Spanish
    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 Source
     
    Medical Appointment Forms - Spanish
    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.

     3.  2017 - 2018 Fisico para Deporte
     
     
    Southwest Behavioral Referral Form - Spanish
    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 Spanish
     
    Vision & Hearing Forms - Spanish
    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 Form
     
    Requirements for AHCCCS - Spanish
    The checklist below will assist you in determining what documents you will need.

    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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