Michael Braun

"You create a good future
by creating a good present."

Eckhart Tolle

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 marpearlcontactme@gmail.com

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

Driver's License

Choose Files
Max File Size 15MB
Choose File
Max File Size 15MB
Choose File
Max File Size 15MB

Office Location: 3293 Fruitville Road, Suite 104, Sarasota, FL 34237