"You create a good future
by creating a good present."
Client Information Form
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.
Insurance and Driver's License Files
You have 2 options to send copies of the Insurance Card and Driver's License:
1) Click on the buttons below to securely forward 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
Important: Photos/images must be in one of the following formats if uploading: .jpg, .png, and .gif. and under 15 MB.
If not, click on the blue Click to SUBMIT button and directly email the images.
Front of Insurance Card
Back of Insurance Card