-Keith McLeod
Patient Registration
New Patient Forms & Information
Please print, fill out and bring in the forms provided for your first visit to our office or to update your information. Please arrive 15-20 minutes early for your paperwork to be processed and to keep your appointment running on time.
* If the patient is under 18 years of age, please download and complete this form:
Consent for Treatment of Minors
New Office Policy: Effective March 31, 2008
If you arrive 15 or more minutes late for your appointment, you will be rescheduled.
Contracted Insurance
The following insurances are those we are currently contracted with. Always check with your insurance to be sure we are contracted if there is any concern.
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Aetna Medicare Open OA HMO
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Healthnet
First Health / The First Health Network
Interplan |
Pima Dermatology does not participate with Aetna, AHCCCS, Arizona Foundation for Medical Care, Carondelet Health Plans, Secure Horizons, Humana HMO, Pacificare, Schaller Anderson, Tricare Prime or University Physicians plans.
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.