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 Tel:  800-217-9289                                            

Fax:  888-751-4019                                               

email:  info@Virtus.health                                         

2675 Horseshoe Drive South, Suite 404             

Naples, Florida  34104 

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© 2019 Virtus Health.  All rights reserved.

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Insurance Checklist

To assist you with the enrollment process, here's a handy checklist of all of the information and forms we'll need to process your Virtus enrollment:  

Initial application

Virtus enrollment forms

  • General information: Name, address, phone, email, etc.

  • HIPAA Privacy Authorization

  • Signed HIPAA Privacy Release

  • Insurance Verification

  • Payment Verification

  • Transportation Waiver

  • Signed consent and acceptance

 

Photo / image of front & back of insurance card

Primary Physician referral documents

  • Patient medical history

  • Diagnosis

 

Letter of Medical necessity

Testing information

  • ADOS or IEP documentation