Dr. Arif Mirza MD

WELCOME TO GPP CLINIC!

We are currently accepting limited Cigna or Self-pay patients

Self Pay Pricing

First Visit $299

Follow up Visit $129

Family $109

We are out of network with all other insurance plans

Updated: 04/04/2022

Virtual Appointment Request

Name of Person Making Request*(required)

Email*(required)

Phone*(required)

Relationship to Patient*(required)

Patient Name (First, Last)(required)

Patient Date of Birth (mm/dd/yyyy) & Age(required)

Requested Date* (mm/dd/yyyy) - Please provide 1st & 2nd pref.(required)

Reason for Visit(required)

Patient Gender(required)

Referred By (Doctor, Therapist, Google search)(required)

Accepted Insurance (If your plan is not listed, you will be booked as Self-Pay)(required)

Briefly list your concerns or symptoms: (ADHD Testing, Depression, Anxiety etc.)