Set An Appointment
Visit The Heavens Medical PLC Patient Portal and choose the day and time that’s best for you! Our Portal allows you to access your medical records, make appointments and also allows you to provide feedback.
Complete Your Forms
Please fill out all new patient forms before you arrive. The forms include your medical history, your current medical issues, family history, insurance information, authorizations, etc.
Heavens Medical PLC accepts most major insurance plans from the country’s best providers. We also welcome self-pay patients, and we offer a discount!
BASED ON HIPAA GUIDELINES, THIS WEBSITE IS NOT CONSIDERED A SECURE ENVIRONMENT. DO NOT COMMUNICATE INFORMATION THROUGH THIS WEBSITE THAT YOU, AS THE PATIENT, WANT TO REMAIN CONFIDENTIAL. PLEASE CALL OUR OFFICE AT (480) 646-1001 AND SPEAK TO A REPRESENTATIVE.
- Arizona Priority Care
- Blue Cross Blue Shield
- Care 1st
- Cenpatico Integrated Care
- Champ VA
- Health Choice
- Health Net
- Maricopa Family Care
- Medicare Advantage
- Meritain Health
- Phoenix Health Plans
- United Healthcare
- University of Arizona Health Plans
We welcome self-pay patients and offer a discount. Payments are due at time of service.
* If you don’t see your insurance listed please call your insurance company to verify that we are in their system.
* If you are enrolled with an Arizona Exchage/Marketplace/Obamacare insurance, you must call your insurance and get verification that Heavens Medical IS on your plan BEFORE any appointment can be made.
At anytime when you call your insurance company, before you hang up, remember to ask them for a reference number for the conversation – they will only provide when asked.
- New Patient Forms Packet – Download Here
- All new patients are required to fill out a New Patient Info Form Packet. Please print, fill out, and bring ALL the completed forms in this packet, with you to your first appointment.
- Patient History Forms – Download Here
- All new and existing patients are required to have a current Patient History Form on file. We ask that you update this form at least once per year. Please print, fill out, and bring this form to your next appointment.
- Medical Release Forms – Download Here
- If you require us to send or receive medical records on your behalf, please sign and submit a Records Release Form.
- If you want to allow your family member, caretaker, etc to have access to your medical and billing information, please sign and submit a Records Release Form.
- Advanced Directives:
- Arizona Attorney General Life Care Planning Forms & Detailed Information – Visit Site
- Durable Mental Health Care Power Of Attorney – Download Here
- Durable Health Care Power Of Attorney – Download Here
- Living Will – Download Here
- Letter To My Representatives – Download Here
- AZ Secretary of State Advanced Directives Information Packet – Download Here
- After completing the packet of information, you must register your advanced directives with the state attorney’s office. – Register Your Advanced Directives
- Complete the registration agreement. After registering, you will set up a login for the Arizona Advance Health Care Directive Registry. DO NOT SEND ORIGINAL PAPERWORK. – Complete Your Registration Agreement
- Arizona Handicap Vehicle Placards:
ALL new patients: Please make sure that the PCP has been changed to Jason Heavens, MD with your insurance company, BEFORE your appointment. This is verified before you are seen and if we are NOT the PCP listed with your insurance company you will NOT be seen. All new patients are required to bring your completed new patient paperwork, insurance card, Identification and any bottles of medication you are taking. If you have not completed the new patient paperwork, please arrive 30 minutes early to complete this before your appointment.
- All patients are required to inform us of any insurance changes BEFORE the day of your appointment.
- All patients will be required to show their insurance card at every office visit, during check in.
- All payments are due the day of service. If there is an outstanding balance on your account, we may ask you to pay it in full or set up a payment plan in order to schedule future appointments.
The patients have a responsibility to the provider/health care organization which include:
- Patients are responsible for keeping appointments and for notifying the health center in advance when unable to keep appointments.
- Patients are responsible for giving truthful information about their present complaints, past illnesses, hospitalizations, medication, and other matters related to their health.
- Patients should provide information about their expectations of, and satisfaction with, the organization.
- Patients should ask questions when they do not understand their care, treatment or services, or what they are expected to do.
- Patients are responsible to follow their Plan of Care, treatment, or services. As agreed they should take prescribed medication, keep referral appointments, obtain laboratory and x-ray tests, etc. Patients should express any concerns about their ability to follow the proposed plan of care, treatment or services.
- Patients should accept their share of responsibility for the outcomes of care, treatment, or services if they do not follow the care, treatment, or services plan.
- Patient should follow the Heavens Medical, PLC Policies and Procedures.
- Patient should be respectful of Heavens Medical providers and staff. Verbal, mental, physical or sexual abuse by patients towards other patients or staff is not acceptable.
- Patients should not use profanity or be disruptive to other patients. Violence or threatening behavior is not acceptable.
- Patients should be respectful of Heavens Medical, PLC property as well as other patient’s property (refrain from damaging, stealing, etc.).
- Patients should meet any financial obligation agreed to with the organization.
Patients may reach our scheduling center by calling (480) 646-1001 during our regular office hours. You may also request an appointment by leaving a message or by using the Patient Fusion Portal for non-urgent, routine care. When requesting an appointment please include the following:
- Full Name
- Date of Birth
- Phone number where you can be reached during office hours
- Current insurance carrier
- Reason for appointment and date and time that would be convenient for you to be seen.
We will call you back within 24 hours to schedule an appointment. If this appointment is urgent, please call us directly so that we can schedule for a same-day appointment, if available. If you are experiencing a medical emergency, immediately contact 911.
If you are unable to keep a scheduled appointment, we require 24-hour advance notice. If no notice is given, you will be charged either your co-pay amount or $35.00 if you don’t have a designated co-pay amount.
If you need to request your medical records from a previous physician(s) or specialist(s) or you need your records forwarded to another health care provider, you can complete a medical records release form and we will take care of the request for you. However, if you want the record for personal use, you can come to the office and sign a records release and we will copy your records and forward it to you. If your record is going from physician to physician, this is done as a courtesy and no fee is charged; but if you want your record for personal use, there is a minimal fee charged per record. Also, before any record can be sent, your physician will review your records. Due to the extensiveness of this process, your request may take 2-4 weeks. We will expedite this process as quickly as possible.
Certain treatments require the use of prescription medications over an extended period of time. When refills are necessary, they will be provided as follows:
- Call your pharmacy at least two days in advance. Please do not call the office as the pharmacist will contact us.
- Each refill will require an authorization from the doctor. This process may take 24-48 hours. We will not accept refill requests on Fridays after noon.
- It is the policy of Heavens Medical PLC that we DO NOT prescribe antibiotics or pain medications over the telephone. These requests will require an office visit to determine necessity.
Many medications may impair judgment when operating machinery or driving a vehicle. These include medications for pain, antidepressants, and anti-anxiety drugs. Please use caution when taking any medication.
If a referral is needed, the physicians and assistants are happy to complete referrals and forward them on to the specialists you are seeing. Please call or email us a minimum of 48 hours in advance with the following information:
- Specialist name
- Date and time of appointment
- Phone number and fax number
Without complete information, you may be required to reschedule your appointment with your specialist. If your insurance requires a formal referral process, which can take up to 14 business days to complete and have authorized by the insurance carrier.
We strongly request that you check with your specialist before going to any appointment to make sure the referral is in place.
If your provider orders medical tests, ask the provider when the results should be available. The normal time frame is within 7 days.
Once your results are available for review, one of our Medical Assistants will contact you with your results and physician recommendations. If the 7 days have passed and you have not been contacted by our office you are welcome to call us at 480-646-1001 to see if your provider has reviewed the results.
The Department of Health and Human Services has established a “Privacy Rule” to help insure that personal health care information is protected for privacy. The Privacy Rule was also created in order to provide a standard for certain health care providers to obtain their patients’ consent for uses and disclosures of health information about the patient to carry out treatment, payment, or health care operations.
As our patient we want you to know that we respect the privacy of your personal medical records and will do all we can to secure and protect that privacy. We strive to always take reasonable precautions to protect your privacy. When it is appropriate and necessary, we provide the minimum necessary information to only those we feel are in need of your health care information and information about treatment, payment or health care operations, in order to provide health care that is in your best interest.
We also want you to know that we support your full access to your personal medical records. We may have indirect treatment relationships with you (such as laboratories that only interact with physicians and not patients), and may have to disclose personal health information for purposes of treatment, payment, or health care operations. These entities are most often not required to obtain patient consent.
You may refuse to consent to the use or disclosure of your personal health information, but this must be in writing. Under this law, we have the right to refuse to treat you should you choose to refuse to disclose your Personal Health Information (PHI). If you choose to give consent in this document, at some future time you may request to refuse all or part of your PHI. If you choose to give consent in this document, at some future time you may request to refuse all or part of your PHI. You may not revoke actions that have already been taken which relied on this or a previously signed consent.
If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer.
You have the right to review our privacy notice, to request restrictions and revoke consent in writing after you have reviewed our privacy notice.