Quick Contact
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| Please allow 24 – 72 hours for a response to your email. If you have medical issues or more urgent concerns, please contact us at (520) 795-7729. For medical emergencies, please call 911. Thank you. |
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Patient Registration Forms
New Patient Forms & Information
- Please print, fill out, and bring the New Patient Forms with you to your first visit to our office.
- These forms can be downloaded from the links below.
- If you are an existing patient, you may also use these forms to update your information.
- Please arrive 15 - 20 minutes early for your paperwork to be processed and to keep your appointment running on time.
- Please bring your Photo ID and Insurance Card.
Registration
Medical History
HIPAA / Advance Directive
Payment Policy
Credit Card On File Agreement
If the patient is under 18 years of age, please download and complete this form:
Consent for Treatment of Minor
- Please print, fill out, and bring the New Patient Forms with you to your first visit to our office.
- These forms can be downloaded from the links below.
- If you are an existing patient, you may also use these forms to update your information.
- Please arrive 15 - 20 minutes early for your paperwork to be processed and to keep your appointment running on time.
- Please bring your Photo ID and Insurance Card.
Medical History
HIPAA / Advance Directive
Payment Policy
Credit Card On File Agreement
If the patient is under 18 years of age, please download and complete this form:
Consent for Treatment of Minor
| Aetna Health Insurance Arizona Foundation for Medical Care Assurant Health / John Alden Beech Street BlueCross BlueShield CIGNA HealthCare Community Care Network Coventry First Health / The First Health Network Great West Healthcare Health Net | HMN (Health Management Network) RAN/AMN Humana Medicare Railroad Medicare Multiplan PHCS Sterling Option I Tricare West (standard only) Tricare for Life (secondary only) United Health Care Evercare PacificCare Fee for Service AARP Medicare Principal Health Insurance University Physicians Health Care Group |
We file claims to insurance companies providing coverage secondary to Medicare or Tricare, whether contracted or non-contracted. Those claims to non-contracted carriers are crossed over electronically from the primary payer or submitted once by paper as a courtesy to our patients. We are not able to refile or appeal claims to non-contracted carriers. If a non-contracted insurance carrier fails to pay within 30 days of our filing, the balance becomes the patient’s responsibility and will be billed accordingly.
Questions regarding coverage should be directed to your insurance carrier’s Membership Services or your employer’s Human Resources Department. Be aware that many insurance carriers have websites with listings of contracted providers.



