Tell us who you are… Fill in all the required fields.
Please be sure to include a valid and easy-to-access cell number and email address as follow up information will be sent to either or both of these to complete your enrollment.
If you no longer have a HOME PHONE, re-enter your cell phone number in that field.
Tell us who your emergency contact is… Fill in all the required fields.
If your emergency contact does not have a home phone or is more reachable on a cell phone, please use THAT number in the phone field.
Tell us about your insurance… Fill in all the required fields.
The first box should be the NAME OF YOUR INSURANCE PROVIDER. The name of the primary person on the insurance policy – typically you or your spouse – goes in the second box (“Name of Insured”).
Verify the code shown on the screen and SUBMIT.
Once you’ve completed this step, we will verify your insurance and our office will be back in touch with you, typically within 3-4 business days depending on responsiveness of your insurance provider.
We believe that good heart health starts by taking care of yourself, and that the way you approach the growing issue of heart health can make all the difference.