Please fill out this request for an appointment with as much information as possible.The submission process may take upwards of 30 minutes however this process will give us the appropriate information about whether or not we are able to meet your treatment needs. Incomplete forms will not be considered for appointments.
You will need to submit a photo of your insurance card on this form. Please take a photo of the front and back of your insurance card and have it saved on your computer or phone before starting this form. If we do not have a copy of this card we cannot verify benefits and no appointment will be offered.
WE ARE NOT IN NETWORK WITH AHCCCS, MEDICARE, TRICARE, WORKERS COMP, OR EAP programs.
WE ARE NOT IN NETWORK WITH MOST MEDICARE ADVANTAGE PLANS
The only Healthcare Marketplace plan we are in network with is AmBetter.
We are Out of Network for all plans purchased on the Healthcare Marketplace other than AmBetter.
Please note that submission of this form does not guarantee an appointment nor does it constitute a patient-physician relationship.
We are unable to see anyone under the age of 17.
Appointments are scheduled on a case by case basis based on Appointment and Physician availability.
There is currently a wait list for new patients.