Huntington Beach Sports Chiropractor – Huntington Beach, Orange County, CA

Surgery Free Pain Relief using Active Release Techniques

Insurance Verification Form

Without all of these pieces of information will not be able to check your coverage.

Your First and Last Name (required)

Your Email (required)

Date of Birth (required)

Your Phone #

Insurance Carrier’s name
 Anthem Blue Shield Blue Cross/ Blue Shield Cigna Aetna Delta United Other (Include at end)

Member ID#

Type of plan
 HMO PPO EPO HMO/PPO combo

Phone # so we can call them… it is the # that says "providers call" usually

Scan front and back of the card? Upload here!

How did you hear of P3 Sports Care?
 ART site Referral Youtube Web Search Running Forum Expo Race event treatment team

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