Patient Forms

Formas Nuevos Pacientes 

Medical Records Release

Aetna

Ameriben 

AZ Foundation 

AARP Supplement 

Banker's Life

BCBS

BCBS Advantage 

Champ VA 

Cigna 

GEHA 

Golden Rule

Gilsbar

Great West

First Health 

Health Partners

AHCCCS Plans 

APIPA - UHC Community Plan 

APIPA Dual Complete

American Indian Health

Mercy Care

Mercy Care - RBHA

MCP Advantage 

​

University of Arizona 

AZ Complete Health 

Healthnet Commercial 

Healthnet Ambetter

Healthnet Allwell Med Advantage

Humana 

Humana Gold Advantage

Mailhandlers

Medicare

Meritan 

Mutual of Omaha

MVP Healthcare

PHCS

Physician Mutual 

Professional Benefits 

Southwest Services

Three Rivers

Tricare for Life 

Tricare Prime

Tricare Select 

UHC Choice Plus 

UHC Navigate

UHC AARP Medicare Complete Networks

Optum Care

Phoenix Direct Banner

Pinal County