APPOINTMENT HOTLINE: 505-271-9900

New Patient Forms


 

PROUDLY ANNOUNCING OUR NEW SOUTH VALLEY LOCATION!

LOCATED AT: 4401 COORS BLVD SW ALBUQUERQUE, NM 87121
APPOINTMENT HOTLINE: (505) 271-9900 (COORS AND RIO BRAVO AREA)

DR. DANIEL PETERSON IS ACCEPTNG NEW PATIENTS NOW

ALL MAJOR INSURANCES ACCEPTED, INCLUDING MEDICARE, MEDICAID, UNITED HEALTHCARE, PRESBYTERIAN, BCBS, AND MANY OTHERS!

 

Forms needed for new patient registration are all conveniently available online. All forms are required at the time of check-in. Forms are downloaded in a .pdf format.

Medical History Form

Patient Info Sheet

Financial Policy

Notice of Privacy Practices

Release of Information

Privacy Page

Welcome Letter

Missed Appointment Contract

 

What to Bring To Your First Appointment:

  • Insurance Card(s)
  • Driver's License or ID card
  • If your plan requires a referral, please ensure that we have your referral. We encourage our patients to bring a copy with them to their appointments, if possible, for added measure.
  • Copay & Deductible (where applicable)
  • Primary Care Physician Name (first and last)
  • Current Medications list
  • Medicare Patients: We are required by Medicare to obtain the date you last saw your Primary Care Physician. Please be advised that we will ask you when you last saw your Primary Care Doctor.
  • *An Important Note About Health Insurance: Since policies and coverage are subject to change, it is the responsibility of the patient to ensure that our physicians are participating with their health plan. Our doctors participate with a very wide array of insurance plans


Your Check-in Time and Appointment Time may differ. Please arrive at your designated check-in time to avoid unnecessary delays or rescheduling.

Our Locations

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