Rapid Covid Testing from $75.00. Results while you wait.

Forms For Your Convenience

Forms for most new patients

Patient Information (pdf)

Past Medical History (pdf)

Consent for Treatment (pdf)

Forms for all Medical Marijuana Patients

You may print and complete these forms prior to your appointment and email to info@coppervalleymedical.com or bring them to your appointment.

Patient Attestation Form - Required by ADHS (pdf)

Patient Information - MMJ (docx)

HIPAA (docx)

Consent for Limited Treatment (docx)

Limited Past Medical History (docx)

MMJ Advisory (docx)

Reproductive Warning (docx)

Release of Medical Records (docx)

Don Selvey, NMD, PLLC

4955 S. Alma School Road, Ste 10, Chandler, AZ 85248 US

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