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20987 N John Wayne Pkwy, B104-275, Maricopa AZ 85139
26 December, 2024
optimizedwellness.info@gmail.com
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Hormone Replacement Therapy
Medical Weight Loss
House Calls
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Home
About Us
Blog
Media Room
Services
Hormone Replacement Therapy
Medical Weight Loss
House Calls
Chronic Care Management
Management of Acute Illness
Preventive Care
Medication Refills
Book Now
Patient Info
Contact Us
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602.767.3900
Patient Information
HIPAA Compliant Online Forms
Please select the lists of forms from below that you would like to fill out.
Medical Weight Loss Program Intake Form
Indemnification Clause
Patient Medical History Form
Telemedicine Informed Consent
Credit Card Authorization Form
Consent to Treat Form
New Patient Registration Form
HIPAA agreement form - Health care operations.
Telehealth / Video Visit
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