Insurance Document Submission
Only complete the form below AFTER your consultation with Dr. Lankster. Information submitted without a prior consultation will not be processed.
When stating your current issues or concerns, please include specific symptoms, dates, and details. If you are submitting documents for a dependent, include the dependents full name and date of birth in your message.
Upload a copy of the FRONT and BACK of the insurance card as well as the government ID of the policy holder.
If you are having difficulty submitting your documentation, you may email your information to firstname.lastname@example.org