If you would like help, we can verify insurance for you. All we need is a copy of your insurance card (front and back) and your date of birth (DOB), or fill out the form below. Please ask for help with this before the day of your appointment. Confidentiality is of utmost importance. Please be assured that we would never share your information.

Insurance Verification

  • Patient Information

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Primary Insurance Information

  • Secondary Insurance (If applicable)

  • Located on the back of insurance card
  • Notes and Uploads

  • Please provide any additional information​ you feel would help us with your insurance claim
  • Digital Signature

  • Please use mouse, stylus or finger to sign form. I authorize Silicon Valley Natural Health to release my medical information necessary to process insurance verification and bill insurance claims.
  • This field is for validation purposes and should be left unchanged.
Please note: * Silicon Valley Natural Health cares so much about safe natural products that we are using CHRISAL probiotic cleaner to clean our office. 
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