Online Insurance Verification Form

Online Insurance Verification Form

  • Accepted file types: jpg, gif, png, pdf, tiff.
    File types accepted: JPG GIF, PNG, PDF, TIFF. An image of the front AND back of the insurance card may also be faxed (352-392-7620) or emailed (verify@shcc.ufl.edu) to the SHCC.
  • Patient/Student Information

  • PRIMARY Insurance Information - REQUIRED

  • OPTIONAL - SECONDARY Insurance Information

    PLEASE NOTE: If including a secondary insurance policy, it is the policy holder’s responsibility to contact both insurance companies listed to verify which will act as primary and which will act as secondary
  • This field is for validation purposes and should be left unchanged.