FOCUS Therapy Insurance Card

Insurance Cards

Please upload the front & back of any health insurance cards.
Name of the Child(Required)
Name of Parent/Primary Caregiver(Required)

Insurance Card 1

Front of Insurance Card #1(Required)
Accepted file types: jpg, jpeg, png, gif.
Back of Insurance Card #1(Required)
Accepted file types: jpg, jpeg, png, gif.

Insurance Card 2

Front of Insurance Card #2
Accepted file types: jpg, jpeg, png, gif.
Back of Insurance Card #2
Accepted file types: jpg, jpeg, png, gif.

Insurance Card 3

Front of Insurance Card #3
Accepted file types: jpg, jpeg, png, gif.
Back of Insurance Card #3
Accepted file types: jpg, jpeg, png, gif.

Note that submission of this form is only for patients who have already been in contact with our office staff at FOCUS. To send a general inquiry, please e-mail us at office@focusflorida.com or submit questions through our Contact Us page.