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Upload your Insurance card and photo ID (Tip: If you have a smartphone, use it!)
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HIPAA
Compliance
1
Will you be paying with insurance or cash/card?
Insurance
Cash Pay
Insurance
Cash Pay
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2
Please provide your phone number
Area Code
Phone Number
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3
Please take a picture of the front of your insurance card
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4
Please take a picture of the back of your insurance card
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5
Please take a picture of your photo ID
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6
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