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New Patient Forms

During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor.  We accept most insurances.

Patient Forms
Please print and fill out the New Patient forms so we can expedite your first visit.

pdf downloadPatient Demographic Form

pdf downloadAssignment of Benefits Form

pdf downloadHIPPA Form

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

  • Patient's insurance card
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient's medical and surgical history
  • Recent test results, x-rays, or relevant records

Insurance and Payment Information

You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please call our office (480) 213-3011. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Insurance we accept:

  • Aetna
  • Arizona Foundation
  • GEHA
  • Assurant Health
  • BCBS Advantage
  • Banner Health Network
  • Champva
  • Cigna
  • Coventry
  • Ghi-Emblem Health
  • First Health
  • Golden Rule
  • Great West
  • Healthnet-AZ Direct
  • Industrial Injuries
  • Medicare
  • Meritain
  • Multiplan
  • Triwest
  • UHC
  • UMR

 

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