Patient Information:

Patient Contact Information:

Patient Insurance Information:
Either claim Number or Policy Number is a required field*       POLICY

All patient benefits are verified prior to EMC reports being sent out. Please attempt to input accurate insurance and claim info, in order to avoid any delays in reporting.

Patients that attempt to check in 30 minutes, or more before their scheduled appointment, or 8 hours after their scheduled appointment shall require their EMC rescheduled by notifying customer service via our contact us page.