Sports Injury & Performance Care – Orange County, California

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 Info@OrangeCountyPainManagement.com with the subject "Insurance Question"

1. Copy of the FRONT and BACK of your insurance card
2. Date of Birth
3. First and last name
4. A phone number we can reach you at

If you can not send a copy of the card, please list your:

1. Insurance Carrier’s name
2. Member ID#
3. HMO or PPO?
4. Phone # so we can call your insurance… it is the # that says "providers call" usually
5. Date of Birth
6. First and last name
7. 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