This page provides a list of all of our forms you can download quickly and conveniently. However, if you are a new patient and need to complete all forms, please follow our New Patient Intake Process.

New Patient Forms

Child Intake

To schedule an appointment for a child between the ages of 3 and 17 years old.

Adult Intake

To schedule an appointment for yourself or an individual ages 18 and older.

Dr. Ruggiero Intake

To schedule an appointment SPECIFICALLY with Dr. Mark Ruggiero.

Authorization Forms

Financial Agreement

Agreement to pay for professional services.

Informed Consent

Consent to treat minor child.

Release Information

Assists with improving communication between professional service providers and important family members.

Request Records

Gives us the ability to request or share important documentation that will help us provide you the best care possible.

Being thorough on your intake forms and completing them before your scheduled appointment will help you maximize your time with your specialist. Help us help you by submitting forms by the deadline and bringing any prior medical records or important documents to your appointment.  Plan to arrive a little early if it’s the first time coming to one of our locations and call us with at least 2 business days notice if you need to cancel or make a change to your appointment.

Schedule An Appointment

Call to talk with a Serin Center representative to discuss your particular needs and to schedule an appointment at any of our Arizona locations.

Client appointment hours:
Monday – Friday 9:00am – 7:00pm
Saturday by availability

Administrative office hours:
Monday – Friday 8:00am – 5:00pm

(623) 824-5051