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Patient Form at Centra Internal Medicine in Arizona
Please complete the Patient Form at Centra Internal Medicine to streamline your visit and ensure we provide the best care possible.
New Patient Intake Form
Fill Out the New Patient Intake Form to Get Started!
Consent to Obtain Medication History
Start with Consent to Retrieve Medication History!
No Show / Late Cancellation Policy
Understand Our No Show / Late Cancellation Guidelines!
*In case of a life threatening emergency, immediately call 911.
**For any medical procedures, patients may respond to treatment differently, each patients results may vary.
***The photos on this website are for illustrative purposes only. The individuals pictured are models unless explicitly identified as a client/patient/customer/staff/employee.
****Information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content contained on or available through this site is for general information purposes only.
*****By using this website and sending us your information, you are giving us permission to contact you by electronic and non-electronic means. (Permission for SMS/Text messaging is only obtained via explicit opt-in checkboxes on our contact forms). We also track conversions and collect user data to improve services, excluding mobile numbers and SMS consent data.
******3rd party tracking services, like Google Analytics, Google Tag manager, Facebook, Instagram, Meta Pixels track, collect and use IP address and other data and location data about patient PHI.
Read complete notice.
*******If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact us.
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