Your Insurance
Add Picture of Your Insurance Card
Upload picture from my computer
Take picture on my mobile phone
Click
here
to upload insurance card later.
Your Insurance
Please help us maintain accuracy by uploading a copy of your insurance card. Select a front and back image of your card.
Click
here
to upload insurance card later.
Your Insurance
Are the registered patients actively covered by a health insurance policy?
IN THE CASE THAT A PARENT OR GUARDIAN IS NOT PRESENT DURING THE TIME OF TREATMENT,
PLEASE LIST BELOW ANY PERSONS YOU WISH TO AUTHORIZE TO GIVE CONSENT FOR MEDICAL
TREATMENT AND PROCEDURES. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT SOME
PROTECTED HEALTH INFORMATION MAY BE SHARED WITH THESE PERSONS.
Add Contacts
Do you want to add the contact now?
Your Insurance
Do you have the insurance card available now?
Book Appointment
Do you want to book an appointment now?
Contact Us
Please contact us with any questions. We hope to serve your family soon.
Your Insurance
Please select your health insurance provider
Your Family Members
Please select the family member whose insurance you would like to enter first:
If you would like to add insurance for another family member, please click a name below:
Please select a family member !
IN THE CASE THAT A PARENT OR GUARDIAN IS NOT PRESENT DURING THE TIME OF TREATMENT,
PLEASE LIST BELOW ANY PERSONS YOU WISH TO AUTHORIZE TO GIVE CONSENT FOR MEDICAL
TREATMENT AND PROCEDURES. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT SOME
PROTECTED HEALTH INFORMATION MAY BE SHARED WITH THESE PERSONS.
