We accept insurance assignments from participating carriers. Most insurance cover our services, please bring with you the insurance card, so that we may fill the appropiate forms. If you are self pay payment is due at the time of services. All our services are primarily by referral, so please bring a prescription from your physician. Please fax your doctors prescription to (239) 936-0047.
We are HIPPA compliant and will not share your personal information unless it is required by law or in the course of the fitting of any prosthetic device with physicians and other healthcare personnel involve in your treatment. You can also request your records to be released to any one by providing a proper record release . If you have any question about the privacy of your information please feel free to call me directly. We care about your privacy. To expedite insurance information please fill the form below. After you are done please call us to verify eligibility.
Southwest Florida Prosthetics Clinic
Insurance Policies
Insurance Details
Company Name
Identification Number
Insured
Patient
Phone
Country
Workers Comp Agent
Please indicate service requested and phone number of workers comp agent and physician
Please fill this form if you are expecting insurance benefits. Also please call us within 24 hours of filling this form at (239) 936-0033. If you prefer you can
fax this form to (239) 936 0047.
