// Loads the Linker plugin ga('require', 'linker'); // Instructs the Linker plugin to automatically add linker parameters // to all links and forms pointing to the domain "destination.com". ga('linker:autoLink', ['https://mylifestylechiropractic.janeapp.com/'], false, true);

Insurance Verification

Please complete the form below so that we can verify your health benefits before your appointment.

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Insurance Provider

Your Policy Identification #

Your Policy Identification Prefix*

Your Insurance Provider's Customer Service Phone Number

(###)

###

####

Insurance Verification

Lifestyle Chiropractic - Greenlake

Lifestyle Chiropractic - Shoreline