Proof of Identity and Insurance (if available) is needed to complete a successful application process.
Provide clear photos (or scans) of Parental identity (for minors under 18 application), and Patient identity (over 18) by submitting a valid drivers license (front), passport (ID page), or green card (front). Also include a proof of insurance (if available) (please submit the front and back of your insurance card).
NOTE: Proof of Identity & Insurance (if available) is a required form submission.
[gravityform id=”14″ title=”true” description=”false”]Return to Telehealth Registration page
