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NEW PATIENT FORMS 

New Patient Registration Form 

Acknowledgement of Privacy Agreement 

Patient Medication List 

Assignment of Benefits 

Medical History 

Accepted Insurance Plans
(Please verify with your insurance plan to determine in-network status and is a referral is required)  

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  • AARP                   

  • Aetna/Meritain

  • AIP

  • All Medicare Supplement Plans          

  • Allwell

  • AZ Foundation 

  • Banner Health 

  • BCBS   

  • Champ VA 

  • Cigna

  • Coventry Mail Handlers 

  • Devoted Health 

  • First Health 
     

  • Gilsbar
     

  • Health Net 
     

  • Humana 
     

  • Medica 
     

  • Medicare/ RR 
     

  • Multi Plan 
     

  • TriCare (Health Net) 
     

  • TriWest/ WPS- VAPC3
     

  • UHC
     

  • UMR

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