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Patient Resources //

New Patients

New to Our Practice?

Thank you for choosing us to be your Medical Provider.  Please download the forms below and have them completed prior to your first appointment.  If unable to download, please arrive 30 minutes prior to your visit to complete the forms in office.  Thanks! 

New Patient Forms
(Please Complete)
HIPPA Information
(Read Only)
Insurance Information

Insurance Information

At Shelter Island Medical Group we strive to be accessible to everyone in our community.  We accept nearly all PPO plans as well as Tricare and Medicare.  Unfortunately, we do not accept Medi-Cal plans at this time.  Check for your health plan below!  

  • Aetna

  • Aetna Medicare Advantage

  • Alignment Health Medicare Advantage

  • Anthem Blue Cross

  • Anthem Blue Cross Medicare Advantage

  • Blue Shield of California

  • Blue Shield of California Promise Medicare Advantage

  • Cigna

  • Health Net

  • Health Net Medicare Advantage

  • Humana Healthcare Advantage

  • Arizona Foundation

  • Beech Street

  • Beech Street (Workers' Comp)

  • Coventry / First Health

  • Coventry / First Health (Workers' Comp)

  • Focus Healthcare

  • Fortified Provider Network

  • Galaxy Health Network

  • Great-West Healthcare

  • Health Management Network, Inc.

  • Humana ChoiceCare

  • Interplan / HealthSmart

  • Interplan / HealthSmart (Workers' Comp)

  • Medicare

  • Mercy Physicians Medical Group

  • Meritain Health

  • MultiPlan

  • MultiPlan (Workers' Comp)

  • Pacific Foundation SISC (Workers' Comp)

  • Pacific Foundation for Medical Care

  • Pacific Health Alliance

  • Prime Health Services

  • Private Healthcare Systems (PHCS)

  • Scripps Employee Medical Plan

  • Scan Medicare Advantage

  • Scripps Health Plan

  • United-AARP Medicare Advantage

  • United Healthcare

  • St. Paul's Eldercare

  • Three Rivers

  • Three Rivers (Workers' Comp)

  • Tricare 

  • United


  • USA MCO (Workers' Comp)

  • If your insurance is not listed, please call our office so that we may verify. 

Contact a Doctor

To leave a non-urgent message for your doctor, nurse or other medical staff please call 619-223-2668.  Please allow at least two business days for us to respond.  If you have a medical emergency, please dial 911.


Prescription Refill Requests

There are 2 ways to refill your medications:


1) Pharmacy: The best way to obtain a refill of your prescription is to contact your pharmacy, even if you are out of refills. Your pharmacy should fax your refill request to 619-223-2668.  Please allow 2 business days for refill request to be processed.


2) Medical Center: Patients may still request refills by calling us at 619-223-2668. If using this method please allow 5 business days for each request to be processed.


Referral Requests

Often times referral requests require authorization from your insurance carrier. You can request a referral by scheduling a appointment with Dr. Saleh. 


Patient Privacy

Shelter Island Medical Group is committed to protecting your privacy and is required by applicable federal and state laws to maintain the privacy of your protected health information. "Protected health information" is your individually identifiable health information, including demographic information, collected from you or created or received by a health care provider, a health plan, your employer, or a health care clearinghouse that relates to: (1) your past, present, or future physical or mental health or condition; (2) the provision of health care to you; or (3) the past, present or future payment for the provision of health care to you.

Patient Requests
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