New Patient Registration

Please fill out All New Patient Registration forms (located down below) and drop off at the office or email to admin@optimalcw.com. 

You must submit the New Patient Registraton forms in order to schedule an appointment.

• An "authorization to release protected health information" (PHI) is a document that, when signed, allows healthcare providers to share a patient’s protected health information with specified individuals or organizations, according to the details stipulated in the form.

• A signed authorization form must be obtained from a patient before their protected health information can be shared with other individuals or organizations.

• To submit a request for medical release of information, please download and complete the '"Medical Records Request" form (located at bottom of page) and submit along with a photo ID. 

• You can submit in person at the office, email, or fax to 928-267-4091.

• Please allow 3-5 business days to receive your records.

• Please call 928-257-1223 with any questions.