Patient Forms

While our Electronic Medical Records registration process gathered your patient history and patient information, provided below are forms you may find helpful:

Please bring all pertinent medical records, test results and a list of current medications and dosages. Prior to arrival, please go to My Registration click on the New Patient link and input your registration information.

Many new patients find it helpful to bring a list of questions. You are also welcome to bring a friend or family member to your appointment.

In an effort to expedite the registration process, we encourage all patients to bring the following items to each visit:

  • A list of current medications and dosages
  • Medical records or test results
  • Insurance card(s)
  • Co-pay (We accept Cash, Discover, Visa and MasterCard)

As a courtesy to other patients, cancellations should be called into the office a minimum of 24 hours in advance. Should you fail to cancel, you may be billed for the scheduled time.

Insurance Providers

Our practice is contracted with a wide variety of plans including, but not limited to, those listed below. We will work to obtain pre-authorization or pursue out-of-network coverage when appropriate.

  • AARP Medicare Complete
  • Aetna (Medicare, Comerica)
  • AHCCCS Fee-for-Service
  • Ameriben
  • APIPA (UHC Community Plan)
  • Arizona Foundation for Medical Care
  • Arizona Medical Network
  • BCBS (Commercial)
  • Beech Street
  • Bridgeway (Advantage & AHCCCS)
  • CareMore
  • Cigna (Senior/Spring, Commercial)
  • Coventry/ First Health
  • Department of Labor
  • Fortified Provider Network
  • Galaxy
  • GEHA
  • Gilsbar
  • Golden Rule
  • Great West
  • Health Management Network AMN/RAN
  • Health Net (Medicare, Commercial, Marketplace, AHCCCS)
  • Health Smart
  • Humana (Medicare, Commercial)
  • Lifeprint/ Optum
  • Maricopa Health (Advantage & AHCCCS)
  • Medicare
  • Meritain
  • Meritus (PPO only)
  • Phoenix Health Plan (Abrazo & AHCCCS)
  • Presbyterian Health Services (Medicare Advantage Replacement Plan”
  • Railroad Medicare
  • SCAN/ Optum
  • Secure Horizons/PacifiCare
  • Tricare
  • UHC Community Plan/APIPA (Dual & AHCCCS)
  • UMR
  • United Healthcare (UHC)
  • University Health (Advantage & AHCCCS)
  • VA/ TriWest Alliance

The Arizona Brain & Spine Center is not contracted with Banner Network.

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