Insurance Verification Form

We are excited to welcome you to our RINT family and we look forward to helping you achieve optimal health and wellness!

Instructions for completing our Insurance Verification Form:

  1. Please fill out all information requested below.

  2. Please make sure to include your member ID (typically on the front of your insurance card) and your date of birth in the form below. Both are required for us to verify benefits.

  3. Click the submit button at the bottom of the form once completed

  4. Once your form is received on our end, a member of our team will contact you within 1 to 2 business days to let you know about your insurance plan coverage for Medical Nutrition Therapy.

We are excited to welcome you to our RINT family and we look forward to helping you achieve optimal health and wellness!