FOR NEW PATIENT FORMS – Please print all forms.
(Patient must update forms if they have not been seen at our clinic in the last three years.)
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Authorization for release of patient health information
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PARTICIPATING NETWORKS
This is not an inclusive list and an insurance provider listed here does NOT guarantee participation,
please contact your insurance carrier directly to verify our participation status with your insurance.
Blue Cross of Idaho, Traditional ,PPO
Regence Blue Shield, Traditional, PPO
Idaho Physician’s Network, SelectHealth, BrightPath, MT Health Co-OP,United Health Care, Ameriben, PacificSource, Aetna, Great West, Cigna, ODS, Idaho Medicaid, Triwest/Tricare, and Medicare Participating providers.
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