ID and Insurance Upload
If you are a new patient or an established patient needing to update your insurance, uploading your Driver’s License/Government Issued Photo ID and your Insurance Card will ensure the check-in process for your first appointment will be as quick as possible.
INSTRUCTIONS
With your smartphone, take a picture of the front and back of your Photo ID and Insurance Card prior to starting this form. To upload your images, click the “Choose File” button below and locate the image on your phone. Contact our office between 8:30 am and 4:30 pm M-TH if you have any questions. NOTE: Your files are fully encrypted with HIPAA-compliant software to ensure your security and privacy.
Drivers License Front
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Drivers License Back
*
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of
Insurance Card Front
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of
Insurance Card Back
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of
Name
*
First Name
Last Name
Submit
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