John W. Bass, M.D. Plastic Surgery

New Patient Registration FGorm 2022

    • JOHN W. BASS, M.D., LTD.

    • (602) 485-1010

    • (Please Print Legibly & Fill In or Correct All Fields)

    • I understand that office visit charges are payable on the day service is rendered. I authorize Dr. Bass to bill my insurance company. Regardless of insurance coverage, I am responsible for all bills being paid in a timely manner. I understand that my contract is between Dr. Bass and myself.

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