Thank you for choosing Izzy Pain and Wellness. To schedule an appointment, please call us at (602) 595-2986.

Patient Forms

Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Please be sure to bring them with you to your first visit or you can email the completed form to us izzypain15@gmail. Completing the forms prior to your visit will help speed up the new patient registration process.

Downloadable Forms:

IPW – New Patient Registration Form

IPW – Authorize to use or disclose health information HIPPA Form

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the image below.

INSURANCE/PAYMENT/BILLING

Public Insurance Plans

Most AHCCCS Plans (Please call for clarification)

Private Insurance Plans

Please call for clarification

Exchange Plans

• Ambetter Health Plan for the Maricopa County Insurance Exchange plan.

Self-Pay

We provide affordable cash pay for our patients without insurance. We accept cash and all major credit cards, please call the office at (602) 595-2986 for details.

NOTE: If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, you will need to pay at the time of your visit. For your convenience we accept cash, Visa, MasterCard, Discover, and American Express. Please note that we do not accept checks.

PRESCRIPTION REQUESTS

Prescriptions and refills for established patients of Izzy Pain and Wellness are routinely issued during our regular office hours. You can make your request by calling our office at (602) 595-2986. No refills are issued after office hours, weekends, or holidays, as our providers do not have access to your medical records during those times. Anticipating your refill needs to avoid an interruption in your medication will be helpful.