Quick & Easy Insurance Verification
In order to save time during your appointment, and provide you with the most accurate estimate posible, we give you the option to provide us your insurance information online.
**You don't have to have fill out all fields, but the more information you can give us the better"
So take out your insurance card! :-)
Who is your insurance provider (Ex. Aetna, Metlife, etc)
Who is the main subscriber? It is usually yourself, a parent, or a spouse.
Patient's Name (If different from Subscriber)
Subscriber's Date of Birth
Employer That Provides The Policy
** If self insured, please write "Self Insured"
Subscriber ID Number
If one is not listed, skip to the next line.
If Subscriber ID is not listed, what is the Social Security # of the Subscriber?
Cust. Service Phone Number
It's usually a 1-800 number in the back of the insurance card (sometimes in the front)
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