• Aetna
  • Allwell
  • APIPA Personal Care Plus
  • AZ Complete Health
  • Banner University Health Care
  • Blue Cross & Blue Shield
  • BCBS of Arizona
  • Cigna PPO
  • Health Net
  • Humana
  • Medicare
  • Medicare Railroad
  • TriWest
  • United Healthcare
  • Universal Health Care
  • University Care Advantage
  • University Physicians Healthcare

If you have questions or need assistance about any other insurance plan, please call our office at (928) 317-9200 or fill out our online Contact Form.

The following form can be downloaded to your computer and printed at home. By filling out this form ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out this form, please do the best you can and our staff will assist you with your questions on the day of your visit.

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.