Send Documents Securely

Questions?

We are happy to help you fill this out:

Call 800-883-1549
Text (517) 657-5223

Send us documents securely

Use this form to send photos or files of your insurance cards (front and back), a photo ID, or any other paperwork we ask for. Everything you send is encrypted. On a phone, tap Add file to take a picture or choose one from your photos.

Patient first name

Patient last name

Patient date of birth

Phone number

Email address (optional)

What are you sending? (check all that apply)

Insurance card(s)

Photo ID

Prescription or doctor paperwork

Income documents (Patient Assistance)

Other

Files (photos or PDFs)

Add file

Please upload a file

Message (optional)

Your information will be encrypted.