New Patient Forms
Please print and fill out the following forms to bring for your appointment. Please call the office at 575-521-3270 if you have any questions.
New Patient Form (2019 Update)
Prescription Refills: Please call your pharmacy at least one week before you are out of your medicine so that they will fax us a request for refill. Our office needs at least 72 hours for all prescription refills.
Uninsured Patients: Payments for services is due at the time of services. For your convenience, we accept VISA, Master Card, cash, checks and money orders. If patient is unable to make full payment you can discuss payment arrangements with our billing department.
Insurance Patients: We will bill most primary and secondary insurance carriers for you upon receipt of a valid insurance card. Please be aware that although we participate with most insurance companies, it is your responsibility to make sure we are a participating provider with your plan.
Auto or Workers Compensation: We do not provide services for auto or worker's compensation patients.
Cancellation Policy: Our office requires 24 hours notice for the cancellation of appointments.
Additional Charges You May Be Responsible For:
Returned Checks $25.00
Copies of Medical Records $25.00 first 10 pages, $1 each additional page
Missed Appointments $0
Overpayments: We will not refund credit balances less than $1.00.
What Should I Do in the Event of an Emergency: We are always available in case of a cardiac emergency. Call 911 for all life threatening emergencies and the hospital will notify your provider.