Add Insurance Information for {{ $doctorOrder->patient->name }}

Note: You are adding insurance information on behalf of the patient. After adding the insurance, you will be redirected to the insurance verification form to complete the verification process.

Patient Information

Name: {{ $doctorOrder->patient->name }}

Email: {{ $doctorOrder->patient->email }}

Doctor: {{ $doctorOrder->doctor->name }}

Insurance Provider

Plan Details

Cost Information

Additional Information

Cancel Add Insurance & Continue to Verification