Welcome to NATIVE HEALTH!

We are honored that you have chosen NATIVE HEALTH to care for you and your family. We are committed to providing quality health care that serves you and your family, at NATIVE HEALTH’s Patient Centered Medical, Dental, and Behavioral Health Home.

Our mission is to provide accessible holistic patient centered care, to empower our community to achieve the highest quality health and well-being. In the tradition of our Native American heritage, we demonstrate hospitality and respect toward every person we encounter. At this time, there are in-person medical, behavioral health, and emergency dental appointments. Telephonic and virtual medical, behavioral health, and emergency dental appointments are also available (Monday-Friday, 8:00 a.m.-7:00 p.m.)

We understand that times have changed, and therefore the way we normally welcome you as a new patient is different.

For that reason, if you have any questions at all while reviewing and signing these forms, please feel free to reach out to ANY of the following individuals, regardless of which site you would like to utilize, while completing paperwork:

• Jose Arturo Lopez-Leon, Medical – (602) 279-5262, ext. 34014 –  jleon@nachci.com
• Brooke Clark, Medical – (602) 279-5262, ext. 14017  –  bclark@nachci.com
• Gina Begay, Dental Customer Service – (602) 279-5262, ext. 14010 –  vbegay@nachci.com

To make sure your New Patient Paperwork process goes smoothly, please take a moment to review this checklist before completing your paperwork online or returning it in person.

• Did you PRINT, INITIAL, and/or SIGN your name on all of the paperwork in this packet where you see the word “client”, “patient”, “guardian”, and/or “legal representative” or complete the entire online packet?
• Please ask us for any COPIES of any of the forms you would like a copy of.
• You will be asked to provide the front desk with a copy of your ID, Tribal ID, court and/or legal documentation or guardianship paperwork, and your AHCCCS or insurance card (as applicable).

Again, welcome to NATIVE HEALTH. We are looking forward to working with you!

Review:

• Notice of Privacy Practices
• Notice of Nondiscrimination
• Your Medical/Dental Home Guide
• Notice of Health Information Practices

Forms to fill out:

• New Patient Registration
• Health History
• Informed Consent for Telemedicine/Telephonic Services
• Patient Rights and Responsibilities
• Request for Communication of Medical Information by Confidential or Alternate Means or Locations
• Student, Intern and Volunteer Patient/Client Consent
• Treatment/Payment Agreement
• Credit Card Authorization

Review and Optional Signature:    

• Health Current Opt-Out