New Patient Information

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WE ARE SORRY, BUT WE ARE UNABLE TO ACCEPT NEW PATIENTS FOR UNITED HEALTH INSURANCE.  WE ARE IN NEGOTIATIONS WITH UNITED FOR A NEW CONTRACT.

We are currently accepting new patients for Dr. Munoz ONLY.
Dr. Cawley’s panel is currently full.

Note that Dr. Cawley and Dr. Munoz believe that science-driven functional medicine including healthy lifestyle choices is critical to a person’s health, but traditional medical treatments can also be required to optimize your health.  Both doctors are board certified.

 

FORMS:

If you are a new patient, please download, print and fill out the “Sage-Form-Packet”:

Sage-Form-Packet

(Right Click, and select “save link as” to download and save to your computer.)

In addition to the forms above, please fill out the online form below and one of our staff will call you to schedule your first appointment:

Please be aware that the first appointment is a new patient visit.  Either Dr. Cawley or Dr. Munoz will enter your medical history into our records, perform an assessment, and order necessary tests.  The first visit will not be considered a physical (a preventative appointment) for insurance purposes or disability determination (FMLA, workers comp, etc).

WE DO NOT EVALUATE OR TREAT FOR WORK RELATED INJURIES OR AUTO ACCIDENTS. WE DO NOT COMPLETE FMLA OR DISABILITY DETERMINATION FOR NEW PATIENTS.

We are currently accepting new patients for Dr. Munoz ONLY.
Dr. Cawley’s panel is currently full.

Intake Form:

Name: *
Birthday: *
Address: *
Social Security Number: *
E-mail:
How did you hear of us?: *
Who can we thank for the referral?:

Primary Insurance: *

If you do not have a "Group ID", please enter 0000 in the "Group ID" field.
If there is no insurance phone number available please enter 000-000-0000 
in the phone number field.

Member ID: *
Group ID: *
Group / Employer Name:
Claims Address:
Provider/Benefit Phone Number: *
-

Subscriber same as patient? *

If no, please fill out below:

Subscriber Name:
Subscriber SSN:
Subscriber Birthday:
 /  / 

Do You have Secondary Insurance? *

If Yes, please fill out below:

Secondary Insurance
Secondary Member ID:
Secondary Group ID:
Secondary Claims Address:
Secondary Claims Phone:
-

What is the best time during office hours for us to call you to schedule an appointment?

Best Contact Phone: *
-
. *
Secondary Contact Phone: *
-
.. *