***PLEASE COMPLETE BOTH PART 1 & PART 2***

Part 1: Online Intake

TIPS:

- It's easier for some to complete Part 2 (below) first so that when Part 1 (above) opens a new webpage, you don't have to come back here for Part 2 (Insurance)        

- Complete Part 1 (Intake) on a computer (not phone) for best results 

- Before you click on Part 1 (Intake) make sure you have photos of your ID and Insurance (Front/Back) already sitting on your computer desktop so that you can upload them into the form

Part 2: Insurance Info (Complete this one before Part 1 above)

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Once you submit both forms, the biller will IMMEDIATELY start working on verifying your insurance, please give us a few days to call you back to schedule your appointment once you are approved.

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