The form below MUST be dropped off to the Front Desk in office.
We require all new patients to complete the “New Patient Application.”
Once dropped off, one of our Patient Care Representatives will call you within 7 to 10 working days on whether you have been accepted as a new patient, and any further information.
Insurances we are currently accepting new patients in:
| Aetna | PPO Only / Call their insurance if we are in their network |
| Cigna | PPO Only / Call their insurance if we are in their network |
| HMA | |
| HMAA | |
| HMSA | PPO/HMO/Akamai Advantage |
| Medicare | with Secondary Commercial plan only |
| Tricare For life *Retired Military* | Must have Medicare or Commercial Plan as Primary |
| UHA | |
| UHC | PPO & AARP Medicare Advantage |