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Superstition Family Medicine

Superstition Family MedicineSuperstition Family MedicineSuperstition Family Medicine

Make Primary Care Great Again!

Make Primary Care Great Again!Make Primary Care Great Again!

Download forms here or complete in office

Adult Primary Care

Pediatric Primary Care

Pediatric Primary Care

Pediatric Primary Care

Pediatric Primary Care

Pediatric Primary Care

CDL Driver Physical

Pediatric Primary Care

CDL Driver Physical

Primary Care Forms

AIA Sports Physical Form 2022-2023 (pdf)

Payment and HIPAA Form (docx)

Recurring Payment Authorization Form (docx)

Patient Demographics (docx)

Medical Records Release Form (docx)

Patient History Form (docx)

Menu / Price List

Primary Care Services Included in our Concierge Contract ($50/month)

New Patient Initial Visit

$120 value

Follow ups and same day visits

$60 value

TB Skin Test & Interpretation

$15 value

Urgent Care/Sutures

$140 value

Vitamin B12 Shot

$20 value

Toradol Shot

$25 value

Rocephin Shot

$30 value

DOT Physical

$50 value

Sports Physical

$25 value

Work Physical

$50 value

Strep Test

$10 value

Pregnancy Test

$5 value

Urinalysis

$10 value

Breathing Treatment

$30 value

Testosterone Refills

$50 value

Other Services

B12 10mL Bottle with #10 needle kit

$60

B12 30mL Bottle with #30 needle kit

$120

IV Hydratio n Normal Saline

$120

FMLA Paperwork

$100

Worker's Compensation Paperwork

$100

Disability Paperwork

$120

Handicap Placard DMV Form (Must be an established patient)

$25

Second Opinion Consults

$50

15 - 20 minute sessions

Weight Loss Services

Semaglutide (Ozempic) & Tirzepatide (Mounjaro) Patient Self-Administers Weekly (saving the patient hundreds of $$$)

Initial Visit

$60

Follow up Visit (every 2-3 months)

$30

Initial and follow up visit fees are disregarded if you sign up for monthy concierge program.

Our Partners

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Superstition Family Medicine, LLC

6104 East Brown Road, Mesa, Arizona 85205, United States

Copyright © 2021 Superstition Family Medicine, LLC- All Rights Reserved.

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Announcement

I would like to introduce my sister Misty Jo to my practice as my new scheduler! She is working from her home in West Virginia and will be an asset to this practice. She will be helping me make sure all of you are scheduled appropriately and help improve the timeliness in communication. Please give her a warm welcome when you speak with her.