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Step 1: Provide Insurance Insurance Information
Hint: This is easy from your phone. Have your insurance cards out, and this step takes less than a minute!.
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HIPAA
Compliance
1
We're glad you're here! What is the reason for your visit?
*
This field is required.
I'm sick and I'd like to schedule an appointment.
I'd like to schedule a preventive or annual visit
I'd like to schedule an appointment to establish care
I don't need an appointment. I'd like to providemy information for next time.
Other
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2
How will you be paying for this visit?
Insurance
Cash Pay
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3
Please take a photo of the front of your primary insurance card
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4
Please take a photo of the back of your primary insurance card
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5
Do you have a secondary insurance plan (like a Medicare Supplement)?
YES
NO
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6
Please take a photo of the front of your secondary insurance card
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7
Please take a photo of the back of your secondary insurance card
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8
Please take a photo of the front of your photo ID
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