Step 3 - Your Insurance Information (ORIG)

Step 3 – Your Insurance Information (ORIG)

Your final step is to submit your insurance information.

Click “Step 3” below to finish your reservation.

Member ID# *

Policy Group ID# *

OB GYN First Name *

OB GYN Last Name *

OB GYN Phone *

I formally give permission to process an order and have Hygeia products sent to me, upon approval by my insurance carrier.

Do you agree? *

We take your privacy seriously and have posted all our policies so you know your data is safe. I agree I understand the following policies are in place are to protect my data:

HIPAA,
Plan of Service,
Patient Bill of Rights, Privacy

Do you agree? *

Many times your insurance will cover extra parts and accessories. I agree for these to be sent to me, upon approval by my insurance carrier.

Do you agree? *

Step 3 – Your Insurance Information (ORIG)

Your final step is to submit your insurance information.

Click “Step 3” below to finish your reservation.

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