New Patient Packet
New Patient Forms.pdf
Midtown No Show Change of Appontment Agreement 2023.pdf
Health Information Disclosure (HIPAA):
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.
Call Us: 602-258-9955
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:
Blue Shield of Arizona (BCBS)
Cigna (PPO only)