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OFFICE HOURS

Mon	9-1+2:30-6
Tue	2:30-6
Wed	9-1+2:30-6
Thu	CLOSED
Fri	9-1+2:30-6
Sat	9-12
Sun	CLOSED

**Please call our office to request specific doctors or therapists as not all doctor's and therapists work every day our office is open.

SUGGESTIONS

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Insurance Verification Form

GETTING STARTED WITH COMPLETE FAMILY HEALTHCARE

To successfully submit your insurance information please fill out ALL of the fields below and click the Send Insurance button. Or click here to download a PDF file to print, fill out and bring with you on your first visit! Thank you.

CONTACT INFORMATION:

	Name:
	Contact Phone Number:
	Insurance Company:
	Employer:
	Patient's Date of Birth

INSURANCE INFORMATION:

Insurance Customer Service Phone Number:

Insurance ID or Policy Number:

Group Number:

Name of the Primary Insured:

The Patient's Relationship to the Primary Insured:

Secondary or Supplemental Insurance:

Enter Verification Characters: