Patient Acknowledgement of Benefits and Billing Information
This form is for all new patients, patients not seen within the past three years and returning patients with recent changes to their insurance.
What You Need To Know
To Upload Your Insurance Card(s) and Referral Form:
From your phone: Please take a picture of your insurance card with your camera phone. Then, click on the “Browse Files” button and choose the relevant files and follow the prompts to upload the image.
From your desktop/laptop: If you are working on a desktop/laptop, take the photo with your phone, e-mail it to yourself, download or drag the picture to your desktop screen and click the “Browse Files” button. Choose the appropriate files and follow the prompts to upload the image.
Hint: To upload multiple files, on a PC hold the “control” button while clicking the files you need. On a MAC hold the “command” button while clicking the files you need.
To Learn More We Encourage You To Contact Our Office
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