Please print and complete the following forms.  Bring them to your appointment.

Cuestionario Inicial

Initial Questionnaire

Health plans

Aetna

​

Ambetter

Blue Cross Blue Shield (except blue select plans)

Avmed (Except Engage and Select plans)

Canadian Medical Network

CIGNA

Coventry Workers Comp

Coventry

Dimensions PPO

Evolution Healthcare Systems PPO

Evolution of Care Systems WC

Galaxy Health Network PPO

Global Excel PPO

Health Management Network PPO

HealthSmart PPO

​

​

Healthsun/Medicare HMO

Heritage Summit WC

Maritime Consultansts

Molina

Neighborhood Health Plan

Humana Orthopedix Network

Healthcare Group/Workers Comp

Simply Health Plan/Medicare PPO

Star Healthcare Network

Stratose PPO

Ambetter

United Healthcare

USA Managed Care Organization/PPO