Membership

Current Group ID #

Phone

First Name *

First Name

Last Name

Comments/Questions:

Email: *

Check here to receive email updates

First Name

Choose

Individual coverage monthly

Individual coverage Yearly

Family coverage monthly

Family coverage yearly

Address

First Name

City, State, Zip

Current Insurance Company

Insurance PAL is your patient advocate service. We can help you find a physician, assist with balance billing, coordinate the pre-authorization process between you, your physician and your insurance carrier and we can help relieve the stress of high cost claims by negotiating a reasonable price for services. Give us a try today.

Upload copy of ID card

First Name