Shafa Medical Clinic Midtown Internal Medicine

Patient Portal

New Patient Information :

Pre-registration:

Set up your Secure electronic chart before you visit us by providing us with your contact and demographic information. Once you receive an email from our EHR you can update your health history prior to your visit at the convenience of your home at any time. Upload your Insurance card (front and back of the card), and your legal ID (front and back of the card). When you pre-register, your wait time will be reduced when you arrive to the office with your Insurance card and ID for the completion of your registration. You will be asked to review and sign off on our privacy policy, financial policy, and other forms.

In office Registation:

Complete the New Patient forms. We will verify your insurance at the time of visit. Bring your Insurance card and your ID with you. You will be asked to review and sign off on our privacy policy, financial policy, and other forms. The wait time may vary depending on how quickly your insurance can be verified.

New Patient Forms: You may download this entire packet to fill out before your appointment.

Please also bring the following materials for your first appointment:

Picture ID *

Insurance Card *

Copay due* (If you have a percentage% copay, we will bill you after your visit is completed.)

Medication list (including name, strength, and prescribing doctor)

*These are required for the first appointment. If you do not have them, we will have to reschedule you.

New patient appointments include taking a full history and a brief physical exam. Please note that We do NOT do preventative services on the first appointment/new patient appointment. Preventative services (ie: annual physicals and papsmears) can be scheduled no sooner than the next day.

You are responsible for all copays, deductibles, and procedures that your insurance states is patient responsibility. If you have questions about coverage, please contact your insurance company for more information. We do offer cash discounts to those not wishing to use their insurance/without insurance. FAQ's are at the bottom of the page.

FAQ

I'm a new patient, can I have a physical or papsmear done on my first visit?

Shafa Medical Clinic's office policy is that the first visit with all patients is considered a "new patient" appointment, where their entire history is taken to identify if certain exams and procedures need to be done. Patients are welcome to schedule a preventative visit after this appointment has been completed. Please note that we do not allow new patient appointments and preventative appointments to be on the same day.

I have multiple medical issues that I need addressed, why do I need to make more than one appointment?

It is easier to make sure each problem is address appropriately and in depth one by one. If a patient comes in with multiple medical complaints, each problem is not going to be addressed to the degree it needs to be in the time frame of your appointment. We ask patients to make problem specific appointments to ensure they get the best care possible by Dr. Modesta-Keyhani. How often have you heard of a patient coming in and stating the doctor seemed rushed or didn't address everything? We want our patients to have the best care, and addressing problems as they come up and on a schedule if chronic allows a productive appointment with the doctor.

Frequently Asked Questions

Can I get a same day appointment? Yes. Call us or book online.

What insurance plans do you accept? We accept many insurance plans. We are contracted with all major Payors in the area. At times contracts change, so please inquire before your appointment.

I do not have insurance, no longer have insurance, or are under-insured, can I be seen? Yes. We offer self pay discounts. Call us to discuss competitive pricing for each office visit.

What should I bring with me to my appointment? Please bring your ID and your updated insurance card. We may ask you to update your demographic information each visit.

Can you call in antibiotics or controlled substances like narcotics? For patient safety, we do not call in antibiotics or any controlled substances. As per regulations, we request that you make an appointment to discuss your concerns and these will be addressed on an individual bases upon evaluation and documentation of the condition.

I need a refill, how do I get one? You log in to your secure portal to send us a message. Alternatively, you can call our office, or your pharmacy to request a refill. Due to privacy rules, we do not recommend use of unsecured email for communicating with our office regarding private health care needs. Usuing your patient portal would be the most secure communication method with our office

FORMS:

Medical Records Request:

How can I obtain my medical Records? To obtain a copy of medical records please send us a release of medical records with your original signature.

Medical Record Release Form
Medical Record Release Form
Medical record release form.pdf
Adobe Acrobat document [335.0 KB]

Health History Form
Health History Form
New patient health history form.pdf
Adobe Acrobat document [183.1 KB]

Community Resources:

Caregiver Resources: See www.Caring.com/caregivers for resources.

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Shafa Medical Clinic P.C. 202 East Earll Drive Suite 150, Phoenix Arizona 85012 . USA....Phone (602) 248-8258 ....Fax (602) 248-8259

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