The Arizona Schwartz Group, PC

To request your intake packet forms, mental health forms, or to review our notice of privacy practices, please call 480-899-4077.

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To request your intake packet forms, mental health forms, or to review our notice of privacy practices, please call 480-899-4077.

The Arizona Schwartz Group, PC
  • HOME
  • PROVIDERS
  • SERVICES
  • WEB RESOURCES
  • FORMS AND NOTICES
  • CONTACT/ADDRESS/FAQ

Forms and Notices

Office desk with financial chart, pen, calculator, and coffee.

Intake Packets and Forms

Please carefully select the correct intake packet forms below for the provider you are visiting. Additionally, ensure that you review the Notice of Privacy Practices and complete the Receipt of HIPAA form. 


Scroll down to find the mental health forms required for your appointment. 


Thank You!

Be sure to review the Notice of Privacy Practices along with the intake packet forms and mental health forms listed below.

Contact Us

Psychiatric Forms and Notices

Adult Intake Packet with Credit Card Form (pdf)

Download

Child & Adolescent Intake Packet with Credit Card Form (pdf)

Download

Consent to Release Information Form (pdf)

Download

Credit Card Form (pdf)

Download

NOTICE OF PRIVACY PRACTICES

"Disclosure of the privacy policy and terms of use for AZSchwartzGroup.com, a subsidiary of The Arizona Schwartz Group, PC. The Arizona Schwartz Group, PC is a private group of independent practitioners collaborating to provide a diverse set of mental health services, including providing necessary intake packet forms and mental health forms available to our users.



PRIVACY POLICY


Privacy Information: AZSchwartzGroup.com collects information about users in two ways: 1) Data that online users voluntarily submit through our contact form. 2) Collective tracking data collected when users visit or interact with our site. The collected tracking data is analyzed to understand visitors' use of our site by tracking information such as page views, traffic flow, search terms, and click-throughs. This information is used to assess visitor traffic and to enhance our site. IP addresses are used to analyze trends, administer the site, track user movement, and gather broad demographic information for aggregated use. Importantly, IP addresses are not linked to personally identifiable information. Cookies: This website does not use or place cookies at any time.



TERMS OF USE


1. Acceptance of Terms: AZSchwartzGroup.com provides access to this website subject to the acceptance of this “User Agreement” by all persons accessing, browsing, or otherwise using this Website ("User" or "you"). This Agreement may be updated by AZSchwartzGroup.com periodically without prior notice. We encourage you to review this Agreement regularly for updates or changes. By accessing or using this Website, you agree to be bound by the terms of this Agreement, as revised periodically. When using a particular feature of the Website, you may also be subject to any posted guidelines, rules, terms of service, codes of conduct, or other contractual provisions as noted. In the event of a conflict between any other agreement, rule, or terms of service and this Agreement, the provisions of this User Agreement shall govern. If you have any questions about this User Agreement, please contact AZSchwartzGroup.com.



2. Disclaimer: The contents of this Website, such as text, graphics, photographs, software, and other material ("Content"), are presented for informational purposes only. AZSchwartzGroup.com will strive to include up-to-date and accurate information on this Website, but makes no representations, warranties, or assurances as to the accuracy, currency, or completeness of the Content provided, including third-party information, such as, but not limited to, press releases, articles, or information from third-party websites linked to or from this Website, AZSchwartzGroup.com.



3. No Endorsement of Links to Other Websites: Any links to other sites are provided solely for your convenience and assistance. This Website may provide links or references to other sites, but AZSchwartzGroup.com has not reviewed all of these sites, holds no responsibility for their content, and shall not be liable for any damages or injuries arising from the content of these external sites. It is important to note that, except for information, products, or services clearly identified as being supplied by AZSchwartzGroup.com, we do not operate, control, or endorse any information, products, or services available on the Internet in any way. AZSchwartzGroup.com does not endorse or represent any of these sites, any information, or other products or materials found on these sites, or any results that may be obtained from using these sites. Again, the links found on AZSchwartzGroup.com are for your information only; you, the user, must consider information from any websites linked to or from AZSchwartzGroup.com as unofficial references. At no time does any link to or from AZSchwartzGroup.com replace professional advice, and we recommend that you always consult with a licensed professional for assessments or treatment. If you choose to access any of these other sites linked to this Website, you do so at your own risk.



4. Privacy: You acknowledge that you have read and understand the terms of AZSchwartzGroup.com's privacy policy. You recognize that this Website may link to other sites not controlled by ArizonaPsychiatry.com and AZChildPsych.com and that the collection of your data by these other sites is outside the scope of AZSchwartzGroup.com's control.



5. Use of the Website: You also understand that AZSchwartzGroup.com cannot, and does not, guarantee or warrant that files available for downloading from this Website will be free of infection or viruses, worms, Trojan horses, time bombs, cancelbots, or other computer programming routines (collectively referred to as "Hazards") designed to damage, detrimentally interfere with, surreptitiously intercept, or expropriate any system, data, or personal information. You are responsible for implementing sufficient procedures and checkpoints to meet your specific data accuracy needs and for maintaining a means external to this Website for reconstructing any lost data.



6. System Integrity: You may not use any device, software, or routine to interfere with the proper functioning of this Website. You may not take any action that imposes an unreasonable burden on the infrastructure utilized for the efficient operation of this Website.



7. Acceptable and Lawful Use of Site: Any personal information, computer information, or other information that you provide to AZSchwartzGroup.com in connection with the use of this Website: (a) Shall not be obscene or indecent; (b) Shall not contain any Hazards; (c) Shall not infringe any third party's copyright, patent, trademark, trade secret, or other proprietary rights or rights of publicity or privacy; (d) Shall not be defamatory, libelous, unlawfully threatening, or unlawfully harassing; and (e) Shall not create any liability for AZSchwartzGroup.com, or cause AZSchwartzGroup.com to lose (in whole or in part) the services of its Internet Service Provider(s) or other suppliers. Users shall comply with all applicable laws, statutes, ordinances, and regulations regarding use of this Website.



8. Risk Regarding Internet Use: You assume total responsibility and risk for your use of this Website and the Internet. You acknowledge and agree that any uploads or transmissions made via the Internet and through this Website may be intercepted and used by an unauthorized third party, and all risk associated with such actions is solely yours.



9. No Warranties: AZSchwartzGroup.com does not make any expressed or implied warranties, representations, or endorsements regarding the Website, the content, any merchandise provided through the Website, or on the Internet generally. AZSchwartzGroup.com shall not be liable for costs or damages arising directly or indirectly from any such transactions. It is solely your responsibility to evaluate the reliability, accuracy, timeliness, completeness, and usefulness of all services and content provided through this Website or on the Internet. AZSchwartzGroup.com does not warrant that this Website will be uninterrupted or error-free or that any defects on this Website will be corrected. This Website and the content available on it are provided on an "As is" and "As available" basis.



10. System Outages: AZSchwartzGroup.com periodically schedules system downtime for maintenance and other purposes. Unplanned system outages may also occur. AZSchwartzGroup.com shall have no liability whatsoever for any resulting unavailability of this Website or for any loss of data or transactions caused by planned or unplanned system outages or any delay, mis-delivery, or non-delivery of information caused by such outages, third-party acts, or any other outages of web host providers or the Internet infrastructure and network external to this Website.



11. Indemnification: You agree to indemnify, defend, and hold AZSchwartzGroup.com and its affiliates, officers, directors, employees, and agents harmless from any and all claims, demands, actions, costs, liabilities, losses, and damages of any kind (including attorney's fees) resulting from (i) your use, misuse, or abuse of the Site, or (ii) your breach of any provision of this Agreement. You will cooperate fully as required in AZSchwartzGroup.com's defense of any claim. AZSchwartzGroup.com reserves the right, at its own expense, to assume the exclusive defense and control of any matter otherwise subject to indemnification by you. You shall not settle any matter without the written consent of AZSchwartzGroup.com.



12. Intellectual Property: The Content of this Website is the property of AZSchwartzGroup.com and/or its affiliates or partners and is protected by federal and international copyright and trademark laws or other proprietary rights. These rights are protected in all forms, media, and technologies existing now or developed in the future. You may print and download portions of material from the different areas of this Website solely for your non-commercial use. No portion of this Website Content may be reprinted, republished, modified, or distributed in any form without the express written permission of AZSchwartzGroup.com. You may not reproduce, reverse engineer, decompile, disassemble, modify, transmit, sell, distribute, license, or create derivative works concerning this Website. Certain Contents may be licensed from third parties, and all related intellectual property rights belong to the respective third parties. You may not remove any copyright, trademark, or other intellectual property or proprietary notice or legend contained on the Site or the Content. Any rights not expressly granted by this Agreement or any applicable end-user license agreements are reserved by AZSchwartzGroup.com.



13. Governing Law and Choice of Forum: This Agreement shall be governed by and construed in accordance with the laws of the State of Arizona, exclusive of its choice of law, rules and matters affecting copyrights, trademarks, and patents under United States federal law. You hereby irrevocably and unconditionally consent to submit to the exclusive jurisdiction of the courts of the State of Arizona and of the United States of America located in Arizona for any litigation or disputes arising out of or relating to use of the Site and shall not commence any litigation relating thereto except in such courts. You waive any objection to the establishment of the venue of any such litigation in Arizona Courts and agree not to plead or claim in any Arizona Court that such litigation has been brought in an inconvenient forum.



14. International Users: AZSchwartzGroup.com makes no claims that the Content is appropriate or can be downloaded outside the United States. Access to the Content may not be legal in certain countries or for certain persons. If you access this Website from outside the United States, you do so at your own risk and are responsible for compliance with the laws of your jurisdiction.



15. Severability: If any portion of this Agreement is held to be invalid, illegal, or unenforceable, such finding shall not affect any other provision contained in this Agreement.



16. No Waiver: Any delay or failure by you or AZSchwartzGroup.com to require performance of any provision shall not affect your or AZSchwartzGroup.com’s right at a later time to enforce such provision. No delay or failure of either party in exercising any right hereunder constitutes a waiver of such right or any other rights.



17. Entire Agreement, Updates, and Modifications: This Agreement constitutes the entire understanding between AZSchwartzGroup.com and you concerning the subject matter herein. AZSchwartzGroup.com may, at its discretion, unilaterally amend or modify this Agreement or any other documents referenced here at any time by posting them on this Website. Any revised terms will be effective upon posting. Continued use of this Website constitutes acceptance of any modified terms and conditions. If you have questions about this Agreement, please contact AZSchwartzGroup.com.



18. Assignment: You may not assign your rights or delegate your responsibilities hereunder without the express written permission of AZSchwartzGroup.com. AZSchwartzGroup.com may, at any time, assign its rights or delegate its obligations hereunder without notice to you.



19. Third Party Beneficiary Rights: No person not a party to this Agreement is intended to benefit from this Agreement, and no such person shall have any right to enforce any term of this Agreement.



20. Limitation of Liability: Under no circumstances shall AZSchwartzGroup.com or any other party involved in the creation, production, or distribution of this Website be liable for any direct, indirect, incidental, special punitive, or consequential damages for loss of profits, goodwill, use, data, or other intangible losses (even if AZSchwartzGroup.com has been advised of the possibility of such damages) that result from (I) The use of or inability to use this Website; (II) The cost of substitute merchandise and services resulting from any merchandise, data, content, or services purchased or obtained or transactions entered through or from this Website; (III) Unauthorized access to or alteration of your transmissions or data; (IV) Statements or conduct of any third party on this Website; or (V) Any other matter relating to the Website. You acknowledge that this paragraph applies to all content, merchandise, and services available through this Website. Because some states may not allow the exclusion or limitation of liability for consequential or incidental damages, in such states liability is limited to the fullest extent permitted by law.



21. Accurate Information: In consideration of your use of this Website, you agree to: (a) provide true, accurate, current, and complete information as prompted on this Website; and (b) maintain and update such information to keep it true, accurate, current, and complete. If you provide any information that is untrue, inaccurate, not current or incomplete, or AZSchwartzGroup.com has reasonable grounds to suspect that such information is untrue, inaccurate, not current or incomplete, AZSchwartzGroup.com may suspend or terminate your use of the service and/or decline to permit your continued use of this Website.



22. Feedback: Should you respond to this Website by providing feedback, such as questions, requests, opinions, comments, suggestions, ideas, or the like, such information shall be deemed the property of AZSchwartzGroup.com. AZSchwartzGroup.com shall have no obligation to you concerning such information and shall be free to reproduce, use, disclose, and distribute the information to others without limitation. AZSchwartzGroup.com shall be free to use any ideas, concepts, know-how, or techniques contained in such information for any purpose whatsoever."

  • HOME
  • WEB RESOURCES
  • FORMS AND NOTICES
  • CONTACT/ADDRESS/FAQ

The Arizona Schwartz Group, PC

14301 N 87th Street, Suite 304, Scottsdale, AZ 85260

(480) 899-4077

Copyright © 2020 The Arizona Schwartz Group, PC - All Rights Reserved.

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