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
To schedule an appointment for a child between the ages of 3 and 17 years old.
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.
Agreement to pay for professional services.
Consent to treat minor child.
Assists with improving communication between professional service providers and important family members.
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