Check Insurance Please fill out the form below, and an AWRS representative will be contacting you once we verify the status of your coverage. Name(Required) Patient's First Name Patient's Last Name Date of Birth(Required) MM slash DD slash YYYY Phone Number(Required)Insurance Company Name(Required)Member ID(Required)Group NumberSecurity Question: What is 2+2?(Required)Are you 18 years or older?(Required) Yes No CAPTCHA
