Forms & Payment

Accepts new patients

Medicare Medicaid Workers' compensation Other
Yes Yes Yes Yes

Medical insurance plans and payment options

ACCOUNTABLE HEALTH (VIP/PHN) ADMAR/PRINCIPLE HEALTH AHCCCS-COMMUNITY CONNECTION & HEALTH CHOICE ARIZONA FOUNDATION BLUE CROSS & BLUE SHIELD OF AZ HMO/PPO BEECH STREET CHAMPUS/TRICARE CIGNA HEALTH NET HUMANA MEDICARE PHCS RURAL AZ NETWORK UNITED HEALTH CARE

CONTRACTED INSURANCE-WE WILL BILL ALL FOR ALL SERVICES. COPAY'S ARE DUE AT THE TIME OF VISIT.

PRIVATE INSURANCE-WE BILL SOME PRIVATE INSURANCE. ALL SURGERIES WILL BE BILLED TO THE INSURANCE FIRST AND THEN THE BALANCE BILLED TO THE PATIENT.

NO INSURANCE-PAYMENT ARRANGEMENTS CAN BE MADE IN ADVANCE.

Office information from SIERRA ORTHOPEDICS, P.C.

1. BEFORE YOUR APPOINTMENT

2. NEW PATIENT REGISTRATION FORM

3. NEW PATIENT HISTORY FORM

4. FINANCIAL POLICY

DR KASA NEW PATEINT HISTORY FORM
DR KASA'S HISTORY FORM FOR NEW PATIENTS

PRE OPERATIVE INFORMATION SHEET
FORM MUST BE FILLED OUT AND SIGNED PRIOR TO SURGERY

SURGERY INFO FOR PATIENTS
PINK FORM

Contact Information

Sierra Orthopedics, PC 1780 E. Florence Blvd. STE 106 Casa Grande, Az. USA 85222 View map Phone 520 836-8988 Fax 520 836-7930

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