Which insurance (if any) do you have? (We are NOT a Medicaid provider)

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Enter your insurance ID #. Then click on the right arrow.
What is your Date of Birth?
1. Click on the (YEAR) to adjust to year of birth.
2. Then click on arrows to adjust the (MONTH).
3. Finally, choose a (DAY) of the month.
Please complete the rest of the form below, then click the button below to schedule your appointment.
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