• Call Us: (480) 717-2403
  • Our Address: 1176 E. Warner Road, Suite 216 Gilbert, Arizona 85296
JCPS | Jones Consulting & Psycho-educational Services

Getting Started With Your Care

Getting Started with Your Care

Find all the essential forms for new patient registration, including payment agreements and insurance details. These forms help us understand your needs and ensure smooth billing processes.

New Patient Forms

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New Patient Intake Form

This form collects your personal and medical history, which is essential for your healthcare provider to understand your background and provide appropriate care.

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Notice of Privacy Practices

This form outlines how your personal information will be used and protected; reviewing and acknowledging it ensures you are informed of your privacy rights.

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Agreement to Pay for Professional Services

By signing this form, you agree to be financially responsible for the services provided by the clinic.

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No Show & Cancellation Policy

This form explains the clinic’s policy on cancellations and no-shows; signing it acknowledges your understanding and agreement to these terms.

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Payment Forms

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Credit Card & Debit Card Payment

Complete this form to securely authorize the use of your credit or debit card for payment of services.

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