Insurance Card and Driver's License Submission
Uploading a front and back copy of your insurance card and your driver's license
allows us to verify your insurance coverage prior to your first visit.
You have 2 options to send copies of the Insurance Card and Driver's License:
1) Click on the buttons below to securely upload a clear, readable photo of your PRIMARY INSURANCE card (front and back) along with your current DRIVER’S LICENSE.
2) Scan and Email copies of these to firstname.lastname@example.org
Important: Photos/images must be in one of the following formats if uploading: .jpg, .png, and .gif. and under 15 MB.
Front of Insurance Card
Back of Insurance Card
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