How It Works Insurance Conditions Our Team Locations FAQ About Check My Eligibility
No Cost. No Obligation.

Check My Eligibility

Takes about 5 minutes. We'll verify your insurance and a member of our team will contact you within one business day.

HIPAA Secure
Insurance Verified Before Your Visit
Response Within 1 Business Day

Eligibility intake form

1
Your Info
2
Medical Info
3
Review & Submit

Step 1: Basic Information

Please enter your first name.
Please enter your last name.
Please enter your date of birth.
Please enter a valid email address.
Please enter your phone number.
Please enter your 5-digit ZIP code.
Please select a preferred location.

Step 2: Medical Information

Please select your primary condition.
Please select your insurance carrier.

Step 3: Review & Submit

Please review your information below before submitting. By submitting this form, you agree to be contacted by a PremierMD team member about your eligibility.

Your Privacy Is Protected
Your information is protected under HIPAA and will only be used to verify your eligibility and contact you about your appointment. We will never sell or share your information with third parties.
You must consent to be contacted in order to proceed.
Questions?

What Happens After I Submit?

1

We Verify Your Insurance

Our billing team contacts your insurer directly to confirm your coverage before your appointment.

2

We Contact You

A team member calls or emails within one business day to share your coverage details and schedule your appointment.

3

Your Appointment

You meet with your provider. Most patients are certified at or shortly after their first visit.