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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
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Mail application
We will send you the application via mail to bring to your licensed medical professional
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Download and print or request an application be mailed to you
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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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