Insurance Verification Form
If you would like us to check your insurance coverage before you come into the office please submit the following by email:
Send to us using the "CONTACT FORM" on the RIGHT SIDE BAR with the subject "Insurance Question" (be certain to fill out all boxes on the form, including the math question at the bottom)
- Copy of the FRONT and BACK of your insurance card
- Date of Birth
- First and last name
- A phone number we can reach you at
If you can not send a copy of the card, please list your:
- Insurance Carrier’s name
- Member ID#
- HMO or PPO?
- Phone # so we can call your insurance… it is the # that says "providers call" usually
- Date of Birth
- First and last name
- A phone number we can reach you at
Without all of these pieces of information will not be able to check your coverage.
If you have more questions about insurance coverage for ART® please CLICK HERE
