Interactive Health Concepts, Inc

Please print off this form.

Fill in the form.

Fax complete document to our office.

​Fax number 1-623-234-3541.

Please print off this form   

Fill in the form

Fax completed document to our office.

​Fax No 1-623-234-3541

Please review this notice.

Print off if you desire and keep for your record.

​Fax back the Acknowledgement below.

Please print off this form, sign and fax to

​our office at 1-623-234-3541.

Please complete this form if you would like copies of your medical records sent to others.

Fill in the form

Fax the completed form to our office.

*Mental health records release is subject to scrutiny for safety.

- Specializing in Tele-mental Health Services -