Samireh Z. Said, M.D.

Patient Information and Forms

Please download and print the forms below prior to arriving for your first appointment.

Please download and read the following forms.

2015 Insurance Form

2019 Intake Form

2019 Signature Pages

Notice of Privacy Page

Q&A on Privacy Notices

CyberGuard

HIPAA Rules

We accept the following PPO insurance plans:

AETNA PPO
BLUE CROSS PPO 
BLUE SHIELD PPO
BEECH STREET PPO
CCN PPO
CIGNA PPO
FIRST HEALTH PPO
FOUNDATION FOR MEDICAL CARE PPO
HEALTH NET PPO
MEDICARE
PACIFICARE PPO
PHCS- PRIVATE HEALTHCARE SYSTEMS PPO
UNITED HEALTHCARE PPO