If yes, pleases fill out the sections below.
Our office submits necessary billing and medical information to insurance companies as a courtesy. We may not be able to do this for all insurances, especially for out-of-network insurances. Copays and fees are due at time of service. Coverage is determined by your insurance company and verification of your policy is not a guarantee of coverage. Any services applied towards deductibles or deemed non-covered services are your responsibility.