Insurance Information Form

If the policy is in your name, please use this form.

If the policy is not in your name, please use another form.

Please fill out the following information and press the SUBMIT button
Email address is very important.
Please write FULL EMAIL ADDRESS. (Ex : name@something.com)

E-mail Address[Required]
Patient Name[Required]
Home State[Required]
Daytime Phone Number[Required]
Evening Phone Number
Patient Date of Birth[Required]
Insurance Company Name[Required]
Insurance Policy Number[Required]
Patient Social Security Number[Required]
Group Number[Required]
Customer Service/Verification Phone Number[Required]
Pre-Certification Phone Number[Required]
Comments


We are the pre-eminent center in the world for Non-Traumatic Spine Procedure.

This procedure is totally non-traumatic access for removal of a bulging or herniated disc. This is the most advanced non-traumatic procedure available anywhere, beyond minimally invasive. We are the world leader in this procedure.


We have medical and surgical centers in Beverly Hills, Los Angeles with a staff of world-renowned surgeons, anesthesiologists, neuroradiologists, pain and rehabilitative specialists.

We have regional non-surgical centers in New York, Florida, and Illinois.

Contact Information:
National Phone Number:
800-956-6724
Beverly Hills:
Tel : 310-659-8498
Fax : 310-659-8869
Los Angeles:
Tel: 310-551-0690
920 S. Robertson Blvd.
Los Angeles, CA 90035
New York (New Patient contact):
Tel: 212-710-1339