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(505) 884-1114

Online New Patient Interest Form

New Patient Insurance Verification Form

Please fill out this form if you are interested in becoming a New Patient with Sage Neuroscience Center. Once submitted, our new patient coordinator will work on verifying your insurance and contact you to schedule an appointment. If you have not heard back from us within 72 hours, please call 505 390-1414 to schedule an appointment with our front desk.

  • Basic Patient Information

  • Middle Initial
  • Please include email if you would like a copy of this form.

    Please select all that apply.
  • What type of services are you looking for?
    By selecting "yes" you grant Sage Neuroscience Center permission to contact listed individual in order to schedule your appointments.

  • Insurance Information

    Non-Contracted Insurances

    If you have United Commercial, Tricare, Humana, or Cigna we are not contracted with your insurance company. We would be happy to see you as a self pay patient but will be unable to bill insurance on your behalf.
  • Please include any letters that precede the ID number.
  • Please provide us with the phone number from the back of your insurance card, this will help for faster verification.
  • Enter self if you are policy holder. Otherwise indicate spouse, parent, child, or other.
  • Please include any letters that precede the ID number.
  • Enter self if you are policy holder. Otherwise indicate spouse, parent, child, or other.

  • Let us know who referred you so we can say thank you.
  • By submitting this form, you grant Sage Neuroscience Center permission to contact you and your insurance concerning scheduling of services.
  • Would you like to be added to our Email Newsletter?
  • Please be sure to attend your first appointment with Sage - if you miss it, you will not be able to reschedule the appointment for the next 12 months.

For more information about our services, contact us today at

(505) 884-1114
or get started with our new patient intake process here:
Get Started Today

Our mission at Sage Neuroscience Center is to provide integrated care that empowers those we serve to achieve sustainable wellbeing through our collaborative community of diverse and inclusive healthcare professionals.

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    Phone: (505) 884-1114

    7850 Jefferson St. NE,
    Suite 300
    Albuquerque, NM 87109

    Mon - Thur: 8AM - 6PM
    Friday: 8AM - 5PM

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