Verify Insurance

New Patient Appointment Request

Verify Insurance

Telehealth Login

Verifying your insurance is an intricate part of the process. Our friendly office staff will call you with the details of your co-pays, deductible and visit limitations. Please allow us 24 hours to process your information.

Verify Insurance Form

Name: Enter Name

Email: Enter Email

Submitting Form...

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Form received.

Message: Enter Your Message

Cell Phone: Enter Phone Number

Home Phone: Enter Phone Number

Can we leave a message? Select all that apply.

Phone

Text Message

I prefer no messages to be left.

When is a good time to contact you? Select all that apply.

Morning

Afternoon

Evening

Anytime

Your Insurance Company: Enter Company

Policy ID / Enrollee ID: Enter ID

Insurance Company Phone Number: Enter Phone Number

Policy Group Number: Enter Number

Relationship to Insured: Enter Text

Insured Date of Birth: Enter mm/dd/yyyy

Patient Date of Birth: Enter mm/dd/yyyy

Image Verification:

Schedule a visit today! 586.884.4714

50258 Van Dyke, Suite A

Shelby Township, MI 48317

586.884.4714 • Fax 586.884.4693

Monday - Friday 9am - 5pm

After Hours 5pm - 9pm (available upon request)

Saturday 9am - 1pm

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