PATIENT FORMS:


 New Patient Packet
​
New Patient Forms.pdf​


Cancellation/No-Show Policy:


Midtown No Show Change of Appontment Agreement 2023.pdf


Health Information Disclosure (HIPAA): 


Disclosure.pdf


​

PATIENT HANDOUTS:



Low iodine diet

​
 Diabetes: 

Low Glycemic Index Diet handout


24 hour urine collection instructions


 ​Blood sugar log handout

​

Osteoporosis:

Dietary calcium handout

Patient Resources

Call Us:  602-258-9955

We are not currently accepting new patients with any AHCCCS healthcare plans. 

​
​It is your responsibility to verify your benefits with your insurance provider prior to your appointment.

• Policies:
  ​
  
  ​1.      Cancellation/No-Show Agreement
  
  Please contact our office for ​cancellations or rescheduled appointments at least 24 hours before the appointment. A $50.00 fee will be assessed when appointments are canceled without 24 hour notice. Allowances will be made for unavoidable or reasonably unforeseen circumstances. Services may be terminated if three scheduled appointments are canceled and/or missed. All patients will receive and sign a copy of this agreement at their initial visit. 
  
  
  2.      Late Arrivals
  
  Patients are asked to arrive 10-15 mins before their scheduled appointment times. ​If you arrive more than 5 minutes late for your scheduled appointment, you may be asked to reschedule your visit. Our providers value your time and strive to provide each patient with the attention they deserve. 
  
  
  3.      Co-Pays & Deductibles
  
  ​All co-payments, co-insurance and deductibles are due at the time of service. We accept cash, checks and all major credit cards.

Accepted Insurance Plans:
AARP

Aetna

AZ Foundation

Banner Healthy

Blue Shield of Arizona (BCBS)

Cigna (PPO only)

Humana

Lifeprint

Medicare

TriCare

United Healthcare