New Patient Forms
Medical Release Forms
(Click to Download)
If you require us to send or receive medical records on your behalf, please sign and submit a Records Release Form.
If you want to allow your family member, caretaker, etc to have access to your medical and billing information, please sign and submit a Records Release Form.
Most Major Forms of Insurance Accepted. If you are uninsured we have affordable cash options.
- Blue Cross Blue Shield
- Care 1st
- Health Net
- Mercy Care
- United Healthcare
- University of AZ Health Plans
- Health Net Federal Services
Based on HIPAA guidelines, this website is not considered a secure environment. Do not communicate information through this website that you, as the patient, want to remain confidential. Please call our office if you have any questions.