Arizona Transplant Associates, PC
2218 N. 3rd Street, Phoenix, AZ 85004
phone: (602) 252-2543, fax: (602) 252-3861
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Patient Forms: English
Registration Form
Medical Information Form
Record Release Form
Financial Policy
Financial Policy Q & A
Please Note:
Bring your insurance cards with your completed forms.
Bring radiology films or CD to your office appointment.
Have your referring physician fax records to our office.
Ensure that appropriate insurance referrals/authorizations are received by our office.
Patient Forms: Español
Registro Del Paciente
Información Médico General
Autorización de Documentos Médicos
Por Favor Nota:
Trae las formas completas y su carta de seguro médico.
Trae las fotos radiológicas o disco compacto a su cita con el médico.
Asegure que el médico referido mando los documentos médicos por fax.
Si necesita permiso de su seguro médico, asegurarse que tenemos la forma en nuestra oficina.
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