Insurance and Patient Forms

We accept most private insurance and AHCCCS plans. We also participate with BABY ARIZONA. Flexible payment plans are available for patients who do not have insurance. In addition, we have special prenatal packages for patients who qualify for FES.

Please contact our business manager, Barb Issacson at 602-241-1695 with any of your insurance or payment questions.

Before your first visit please SEE BELOW and fill out the appropriate forms. This will save you much time on your first visit with us and you will be sure to have all the information you need.

Patient Forms:

OFFICE INFORMATION AND POLICIES

PATIENT INFORMATION & INSURANCE

INFORMACION DE PACIENTE Y INSURANCE

INDUCTION OF LABOR CONSENT

CONSENT TO STERILIZATION

CONSENTIMIENTO PARA LA ESTERILIZACION

AUTHORIZATION TO RELEASE MEDICAL RECORDS

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

Just click on all applicable forms below for a printable PDF format form. Adobe Acrobat Reader is a free program and already installed on most computers.

  Click here to downoad Acrobat Reader.

 

link to Baby AZ

link to AHCCCS

 

 

 

 

 

 

 



6707 North 19th Avenue Suite 222
Phoenix, AZ 85015
(602) 258-2264
FAX (602) 258-1710


515 East Thomas Road
Phone: (602) 241-1717
FAX: (602) 265-7216

 



WEBSITE:
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