Insurance Benefits Check Form
Dr. Giles accepts most major health insurance plans as well as auto accident and workers’ compensation claims. Please complete and send this form to receive your complimentary insurance benefits check.
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Insurance Company *
Your answer
Member ID # *
Your answer
Group ID # *
Your answer
Provider Phone Number
Usually found on the back of your insurance card.
Your answer
Questions?
Please send your questions to info@lizgilesdc.com
Submit
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