Forms & Payment

Accepts new patients

Medicare Medicaid Workers' compensation Other
Yes No Yes Yes

Medical insurance plans and payment options

Aetna, Arizona Foundation Medical Care, ASPA, Blue Cross Blue Shield, Beech Street, Cigna All Lines of Service, Great West, Healthnet, Lifewise, One Health Plan, Private Health Care System, Prudential, United Healthcare All Lines of Service

Credit Cash

Office information from Duane D H Pitt, MD

HIPAA Policy

Registration-HIPAA Privacy Acknowledgement
Please complete prior to your first visit.

Controlled Medication Protocol

Medical Records Release Form
Please read and sign if you would like us to release or obtain records from anyone.

New Registration- New Patient Questionnaire (Adobe)
This questionnaire must be completed in full prior to your first office visit with the other registration material listed. Please print these forms from your browser. If you are unable to print these forms, arrive for your appointment 45min early to complete all forms and regestration.

New Registration- New Patient Questionnaire (MS Word)
This questionnaire must be completed in full prior to your first office visit with the other registration material listed. Please print these forms from your browser. If you are unable to print these forms, arrive for your appointment 45min early to complete all forms and regestration.

Oswestry Questionnaire
Please complete only if you are being evaluated for low back issue. For Scoliosis, please see SF-36.

Registration-Acknowledgment Form
Please complete prior to your first visit.

Registration-DISD Registration Form
Please complete prior to your first visit

Registration-Research Release Form
Please complete prior to your first visit.

SF-36 Questionaire
Complete only if you are being evaluated for Neck issues or Scoliosis.

Contact Information

Desert Institute for Spine Disorders 8573 E. Princess Dr. Suite #221 Scottsdale, AZ USA 85255 View map Phone (480) 656-4048 Fax (480) 247-6146

Other staff in my practice

Visit our new web site at
www.AZSpineSurgeon.com


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