Insurance Card Upload
We are asking you to upload images of the front and back of your insurance card (if you have one). If you can't create an image of your card you can also send a fax of your card to 866-587-2383. If you have a cell phone with a camera you can take pictures of the front and back of your card and email them to yourself to upload into our form.
PLEASE USE THE SAME EMAIL YOU SIGNED UP WITH ON THE INTAKE FORM TO SIGN INTO THIS FORM! IF YOU HAVE NOT YET FILLED OUT THE INTAKE FORM, PLEASE SIGN UP FIRST!