File Upload

File Uploads

Please upload an image of your government issued ID and both sides of your insurance card.

First Name(Required)

Last Name(Required)

Email(Required)

Enter Email Confirm Email

Date of birth(Required)

Naming Files…
** We suggest you name your files appropriately before uploading them. For example, in the instruction below, replace “YourLastName” with your actual last name, and “YourFirstName” with your actual first name…
Insurance Cards (2 sided)
YourLastName-YourFirstName-InsCard-Front
YourLastName-YourFirstName-InsCard-Back
Front of Government Issued ID (1 sided)
YourLastName-YourFirstName-ID

Upload Files

Drop files here or

Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 10 MB, Max. files: 4.

Please note…
If your File Upload is NOT an ID or an insurance card, please choose to whom your document should go…

The Document I am uploading is for…

Comments on these files