Insurance Verification Request

Insurance Verification Inquiry Form

  • Coverage varies from policy to policy; therefore, please complete the form below so that we may contact your insurance provider to obtain the details of your exact coverage.
  • All information submitted via the website is confidential.
  • Policies vary widely and it is important to fully understand the following when researching coverage:
    • Whether you are covered.
    • Whether your policy limits the number of visits per year.
    • Whether your policy limits the types of ailments it covers.
    • What your deductible is and whether it has been met.
    • What percentage of the cost your insurance company will cover.
  • Once you submit this form, we will contact you within 2 business days outlining the details of your coverage.
  • All payment is due at the time of visit until coverage is verified. 
  • Please note that the fields with ‘*’ are required fields.