Opt In/Opt Out AZ

Patient Rights Forms

A provider can download the following Patient Rights Forms. Each form is provided in a Generic or Pre-Fillable format to allow a provider or organization the ability to insert their contact information in the Provider Only section of the forms in addition to adding their logo or office address at the top of the form.

Opt Out Forms

Opt Out Forms – English

Opt Out Forms – Spanish

Health Information Request Forms

Health Information Request Forms – English

Health Information Request Forms – Spanish

Opt Back In Forms

Opt Back In Forms – English

Opt Back In Forms – Spanish