Photograph your Insurance Card

Take a photo of your ID and then select Use Photo

Front side

Retake? Go back without using photo

Front

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Confirmation message

Do you want to complete the Open questions?

Please select a Zip Code

Zipcode

The person responsible for payment must be at least 18 years old. Please review if all the information entered for the person responsible for payment is correct. Once you revise the information, click Next to go to the next page.

Information provided is incorrect.

If you think this is a mistake. Please see the front desk staff and ask them to correct your information. Once they do try again from here.

Do you have another insurance to add for this visit?

Yes, I have another insurance

No

Your session was expired. You refreshed your page and for security reasons we expired your session. Please go back to your email/text message click the link again and start the paperwork. Information you entered so far will be stored and you will be asked to verify your identity.

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