Insurance Verification

Learn About Your Insurance Benefits with Us

Several insurance companies offer coverage for the treatments we provide such as acupuncture and manual therapy. Our Insurance Department is happy to verify your insurance coverage after you complete and submit the short form below. Please fill in all information. Missing or incomplete information will delay your request. Thank You.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Date of Birth

YYYY

Sex

Patient / Subscriber ID #

Group #

Insurance Type

Insurance Group

Relationship to Insured

Marital Status

Insurance Company Name

Insurance Company Phone Number

(###)

###

####

Insurance Company

Claim Number (if accident)

Referred By:

Condition or Illness you are seeking treatment for:

Other Information

Choose a treatment location that works best for you

13224 WEST BROWARD BOULEVARD, PLANTATION, FL, 33325

1201 NE 26TH ST #106, WILTON MANORS, FL 33305

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