Insurance Verification Request Form
Please carefully read before requesting insurance verification.
- All information submitted via the website is confidential.
- 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.
- 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 from your insurance.
- Please note that the fields with ‘*’ are required fields.
Please complete the form below. Insurance verifications can up to 2 business days. We will email you the results.