If you're not the policy holder, please fill out policy holder's name and birth date below:
If you're unable to complete the section below by taking a picture of your insurance card or uploading it from your desktop computer below, please make sure to bring your ID card with you for your first visit.
If you don't upload your ID card simply hit submit below and remember to bring your info with you.
If you're on your mobile phone, please click on "choose file" below and take a picture of your Insurance ID card. It will automatically upload your ID info to our system.
If you're on your desktop computer, please click "choose file" below and upload your insurance card info: