The Aleph Center, PLLC
Wholistic Mental Health Care

6408 E Tanque Verde Road,

Tucson, Arizona 85718-3809
Phone: (520)-885-5558
Fax: (520)-885-5559

New Patient Information


To save time and get the most from your first appointment, download and fill out the attachments below:

 

The information here will help your provider get to know you better.  We do not have you fill this out 


online like some websites to protect your personal and health information. 

 

    Intake -  Please fill out to the best of your ability.

 

    Financial Agreement - This explains our fees and financial policies.

 

    Med List - Please note any medications you have taken, doses and how long you took them.  If you recall any known and effects including side effects can be noted to assist your provider in your treatment.        

 

    Patient Privacy Policy  Please read, sign and date. 

 

    Patient Face Sheet - Please fill this out.  This is basic information about you, who referred you, your insurance etc.



NEW PATIENT PACKET: download all five of the above in one PDF file.