• Insurance Card and ID Card Submission Form

    Insurance Card and ID Card Submission Form

  • Please submit the information below regarding your insurance plan so we can ensure your insurance claims are being processed properly with accurate and current insurance information.

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  • Insurance Card

    Please help us assure that all your insurance claims are processed properly. Send us a photo of the front and back of your insurance card. Please try to get the insurance card centered evenly in the screen.
  • ID Card

    Please send us a photo of the front side of your drivers license or state identification card. This is important for verifying your identity when billing your insurance. For minors, please submit the identification card of the parent or guardian.
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