For New Patients
Process & Forms
New Patient Information | Mesa GI Clinic
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Step 1: Make an Appointment - Call 480-461-1088
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Step 2: Complete Your Registration – Do the Paperwork!
All new patients should download and complete all the New Patient Forms – links to download them below. When you arrive for your appointment, please submit your completed forms at reception.
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Remember Your Photo ID, Insurance Card, & Paperwork!
On the day, please arrive 15 to 30 minutes before your scheduled exam time. Please remember to bring your insurance card, photo identification, and completed forms. If you have not filled out our new patient forms, you will be asked to complete them when you arrive. Please also remember to bring any helpful information such as x-ray reports, medical records, and prescription history.
If you need to reschedule or cancel your consultation or procedure, please call at least 24 hours prior or you will be subject to a $25 fee for the consultation and $100 for the procedure.
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Get Directions – Know Where You’re Going!
Use this link to get personalized driving directions to Mesa GI.
New Patient Forms
All new patients should download and complete these forms. When you arrive at our Mesa GI clinic, please give your completed paperwork to our receptionist.
Authorization to Release/Obtain Medical Records
Financial Policy Form
Notice of Privacy Practices
Patient Interview Form
Patient Registration Form
Notice of Nondiscrimination
Consent to release medical information to family/friends
Thank you for your assistance in making your check-in as efficient as possible. We look forward to seeing you on the day of your appointment!
Financial Policies
Payment at Time of Service
We require a copy of your current insurance card at the time of your visit. If you are unable to present your card before seeing the doctor, the visit may be considered fee for services, and full payment may be collected. If your insurance requires a co-payment, deductible, or co-insurance, it will be collected at the time of your visit. If you are an established patient, please verify all insurance information and notify us of any changes.
Verification of Benefits
As a rule, we try to verify all benefits prior to your appointment, but in some cases, this is not possible. It is ultimately your responsibility to make sure you have insurance, we are an approved provider, you know what your benefits are, and you have supplied us with valid insurance information. When required, it is the responsibility of the patient to obtain all needed insurance referrals. In the event your insurance claim is denied, you will be responsible for the services rendered.
After Your Visit
We will file any claims with your insurance carrier. When your insurance processes the claim we will make the appropriate adjustments. You may receive a bill after the insurance has paid if your benefits require you to pay a deductible, co-payment, or co-insurance that was not previously collected at the time of service.
Paying Your Bill Online
For your convenience, you may pay your bill online here
Questions Contact Mesa GI
Our aim at Mesa GI is to help our patients achieve better digestive health and an overall improvement in their quality of life. If you have questions, please call 480-461-1088.