Insurance Verification Form Template

Benefits of using this insurance verification form template

White Labeling Features

Design your medical insurance verification form with your brand colors, fonts, and logo on the welcome screen. If you are sharing the link with your patients or clients through a direct link, you can add your brand name to the link to generate trust and look authentic. You can also remove SurveySparrow branding at the end of the form and add your own.

Multiple Sharing Options

Other than a direct link, you can share the form through WhatsApp, QR Code, Email embed, Webpage embed, and SMS. For healthcare institutions, QR codes can be beneficial. You can place the code at various touchpoints and patients can easily access the form by scanning the code. This speeds up the insurance verification process.

Easy Customization

With our drag-and-drop form builder, you can customize this insurance verification form template the way you want. You can add, remove, or edit fields. Use  20+ question types provided in the builder, to collect comprehensive information. With CSS editor, you can code your background. Don’t forget to try AI features!

Signature & Consent Collection

The form builder has signature and consent collection options. Patients can draw, type, or upload their signatures in the form. They can also upload their digital signatures. This makes the verification process digital, and paperless. Adding a consent box at the end can ensure that the information collected is true.

Connect with Google Sheets

Integrate the form with Google Sheets and automatically collect all information in real-time in a sheet. Access it in the integration tab itself. You can segment the data and get more insights using the features of Google Sheets. This helps you to simplify and improve data management processes.

Get a Printable Insurance Verification Form

Our form builder allows you to download a PDF version of this verification form. A PDF form can be printed and used in clinics and hospitals for collecting patient details manually. This helps in the locations with no internet connectivity. 

Who can use this insurance verification form template?

During the insurance verification process, healthcare professionals collect details from patients to check if the treatment is eligible for insurance. Verifying insurance details can save hospitals, clinics, and insurance companies from billing issues, errors, and fraud.

This insurance verification form template can be used by the following healthcare professionals,

• Chiropractors
• Dental Clinics
• Therapists
• Eye Cinics
• Home Healthcare Providers

How does this insurance verification form template comply with HIPAA guidelines?

SurveySparrow’s HIPAA-compliant features make this sample insurance verification form perfect for the healthcare industry.

Here are the features of SurveySparrow that help you keep patient’s data safe and secure,

• Role-Based Access - The admins can assign role-based access to contributors based on permission to create forms, edit forms, and access and share reports.
• Data encryption - All the information collected from patients is saved through end-to-end industry-standard encryption.
• Two-factor authentication - With the 2-factor authentication, users require the security code to log in to the SurveySparrow account. Even if someone finds your password, they cannot log in without your security code.
• Person or Entity Authentication - SurveySparrow has a policy that describes the process of verifying a person’s identity before unlocking their account, resetting their password, and/or providing access to ePHI.
   

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