Becoming a New Patient

If you do qualify for our services and would like to become a new patient, please download both the New Patient Enrollment form and the Assignment of Benefits Form by clicking on the link below.

Please fax your completed forms along with copies of your insurance card(s) and any Medical Power of Attorney (POA) paperwork if applicable.

After receipt of your paperwork, our New Patient Enrollment Coordinator will contact you for any additional information needed as well as to schedule your first appointment.

Download the New Patient Enrollment Form and Assignment of Benefits Form
Download the Patient Privacy Policy

Or, if you prefer, you may contact our office at (602) 954-0444 to speak with our New Patient Enrollment Coordinator.