Click the Español link on any page to view the page in Spanish.Please note: not all pages are available in Spanish at this time.
How would you like to fill out the application?
Download and print or request an application be mailed to you
Take the application to your licensed medical professional to fill out the Licensed Medical Professional Verification section.
Mail it in to APS
APS Medical Care Program
Mail Station 3211, P.O. Box 53933
Phoenix, AZ 85072