If you are a new patient, please download this form and fill it out before coming to your visit. To download it – just click on the image to the left. If you have problem then right click on it with your mouse and choose “save link as” – this will save the form to your desktop.
New Patient Form – Click to download
Please fill out this online form before coming into your first visit. It is to verify that we can accept your insurance.
We will also need to see your insurance card. If you have a scanner – can you scan the front and back and email it to firstname.lastname@example.org.
Or if you have a smartphone can you take a photo with your phone and text message it to email@example.com.
Insurance Verification Form – Click here for form