Congratulations!  You've Successfully Submitted Your Form!

Your information has been received by our staff and will be reviewed shortly.  You will be contacted in the near future so that we may set up an appointment to meet with you.  Prior to your appointment, we will email you our "Membership Agreement" so that you may fill it out and bring it with you.  At that time we can answer any questions you may have and finalize the required paperwork.  If you prefer not to receive this document by email you may stop by our office during normal business hours and pick one up. 

 

Here's a brief list of items you will need to bring with you to your appointment:

 

1.   Photo Identification

 

2.   Health Insurance Card

      (*Although we do not accept or file insurance, your insurance information is necessary for us to create your "superbill" if you are going 

      to file your claims yourself.  In addition, some referrals and exams at outside agencies may require pre-authorization from your

      insurance company)

 

3.   Your "Membership Agreement"

      It's a "fillable PDF document" that can be filled out on your computer and then printed or you may print it and fill it out by hand.  Please

      print your information legibly and in black ink. 

 

4.  Payment type

      (*A credit card is required to be kept on file for persons paying monthly.  Annual payments paid in full can be made using cash, check, or

      credit card)

 

 

Thank you!

 

ALLIED Health & Wellness, LLC

3101 S. Boyd Dr. (Physical Address)

910 W Pierce St #105 (Mailing Address)

Carlsbad, NM  88220

Phone: 575-689-8233

Fax: 575-689-8968

Email:  contact@alliedhw.com

© 2014 by ALLIED Health & Wellness, LLC