Medical Care program applications

How would you like to fill out the application?

Download application

Download and print the application at home to bring to your licensed medical professional

Download

Mail application

We will send you the application via mail to bring to your licensed medical professional

Learn more

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Download and print or request an application be mailed to you

Person filling out paperwork.

Take the application to your licensed medical professional to fill out the Licensed Medical Professional Verification section.

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Mail it in to APS

APS Medical Care Program
Mail Station 3211, P.O. Box 53933
Phoenix, AZ 85072

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