Patient Forms
Price breakdown for Spectrum services
Self-Pay Consent Forms
Sliding Fee Scale for Northern AZ Region only
Please note that full fee payment is due and payable at the time of service, even if you have insurance, and you are responsible for any and all charges for services received. Payments are due at time of service with cash, check, credit/debit card, cashier’s check or money order.
Patient Pay 0%
Patient Pay 20%
Patient Pay 40%
Patient Pay 60%
Patient Pay 80%
Patient Pay 100%
El Paciente Paga 0%
El Paciente Paga 20%
El Paciente Paga 40%
El Paciente Paga 60%
El Paciente Paga 80%
El Paciente Paga 100%
Formularios de consentimiento de pago por cuenta propia
Escala móvil de tarifas solo para la región norte de Arizona
Tenga en cuenta que el pago completo de la tarifa vence y se paga en el momento del servicio, incluso si tiene seguro, y usted es responsable de todos los cargos por los servicios recibidos. Los pagos vencen al momento del servicio en efectivo, cheque, tarjeta de crédito/débito, cheque de caja o giro postal.
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Spectrum is ready to explore your path to wellness today. Press the chat button or call now 1-877-634-7333. Your mental wellbeing is important to us, take a moment to invest in yourself and see what we can offer!