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Patient Forms

Have an upcoming visit? Save time in the waiting room and update your health forms before you come in.

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New patients

Adult Medical History Form (English and Spanish) [PDF]
Pediatric Medical History Form (English and Spanish) [PDF]

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Virtual care visits

Adult Medical History Form (English and Spanish) [PDF]
Pediatric Medical History Form (English and Spanish) [PDF]

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Before each returning visit

Patient Rights and Responsibilities (English) 
Patient Rights and Responsibilities (Spanish) [PDF]
Notice of Privacy Practices (English) [PDF]
Notice of Privacy Practices (Spanish) [PDF]

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Evernorth Care Group is the medical practice division of Cigna HealthCare of Arizona, Inc. All Evernorth Care Group services are provided exclusively by or through Cigna HealthCare of Arizona, Inc. and not by Cigna Corporation. The Evernorth name, logo and other Evernorth marks are owned by Express Scripts Strategic Development, Inc. © 2025 Evernorth
 

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