Patient Center
Patient Forms
If you have been seen by an ophthalmologist before and would like to transfer your records to our office, please click on the Medical Records Release form below, fill it out, and send it to your previous office. If you are a glaucoma patient, please be certain to obtain your previous records including visual field exams.
New Patient Packet
To save time in the waiting room, please print and complete the forms packet before your appointment.
- New Patient Forms Packet (6 pages)
If you have been seen by an ophthalmologist before and would like to transfer your records to our office, please click on the Medical Records Release form below, fill it out, and send it to your previous office. If you are a glaucoma patient, please be certain to obtain your previous records including visual field exams.
Individual Forms
If you need an individual form, please choose from the list below.
- Patient Registration
- Medical History
- Review of Systems
- Treatment Consent
- Credit Policy and Financial Agreement
- Notice of Privacy Practices
Insurance Information
- Medicare (straight or with supplement)
- Aetna
- Arizona Complete Health
- Blue Cross Blue Shield (includes BCBS Medicare Advantage and BCBS Alliance)
- Care 1st of Arizona Wellcare AHCCCS (also ONECare)
- Cigna
- GEHA
- Health Choice of AZ Steward (AHCCCS) (includes Health Choice Generations)
- Health Net (PPO, Ambetter exchange plan, AHCCCS)
- Humana (PPO and Medicare advantage)
- Mercy care AHCCCS (includes Mercy Care Advantage)
- Meritain Health
- Multiplan
- Tricare
- United Healthcare
We still may accept your insurance even if you do not see your insurance listed here. Please contact our office to verify.
We are out of network for the Cigna Medicare Advantage as well as the AARP Medicare Advantage plans.