A Returning Customer with Insurance
If you are a returning customer and think your insurance and/or address has changed or are not sure if we have correct insurance, please go back to main page and select "paying with insurance".
Date of Birth
Current Insurance Provider
Do you have a current prescription
We cannot file with your insurance without a current prescription (must be dated within the past year). You may have your doctor fax us your prescription on our electronic fax 713-456-2188
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This form was created inside of Women's Health Boutique.
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