Insurance Benefits CheckerNew Patient Intake: Part 0Check Insurance BenefitsDo You Have Insurance?(Required) Yes NoName (AS ON ID CARD)(Required) First Last Email(Required) Phone(Required)Insurance Name(Required)ID #(Required)Group #(Required)Date Of Birth(Required)Secondary Insurance (SKIP IF NONE)Name (AS ON ID CARD) First Last Insurance NameID #Group #Provider Phone #Provider Phone #Date Of BirthUPLOAD INSURANCE CARDSTake a picture or scan your insurance card(s) (front and back) and upload it here.INSURANCE CARD FRONT(Required)Accepted file types: jpg, png, pdf, jpeg, Max. file size: 6 MB.INSURANCE CARD BACK(Required)Accepted file types: jpg, png, pdf, jpeg, Max. file size: 6 MB.INSURANCE CARD FRONT (SECONDARY)Accepted file types: jpg, png, pdf, jpeg, Max. file size: 6 MB.INSURANCE CARD BACK (SECONDARY)Accepted file types: jpg, png, pdf, jpeg, Max. file size: 6 MB.
