Check your insurance.

We accept Regence, Premera, LNI/Worker’s Comp (WA & ID), motor vehicle collision

Please note: We request confirmation of benefits prior to booking your initial appointment with us. This is only a pre-check. You will still be required to complete both the general and Insurance intake forms when scheduling your appointment with us.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Insurance Provider

Policy ID #

Group #

Customer Service phone number

800 # for providers

(###)

###

####

Date of Birth

MM

DD

YYYY

Primary Policy Holder Name

Relationship to Primary Policy Holder

Employer of policy holder

Which office location?

Moscow

Lewiston

Comments

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