Document Submission/File Upload

Document Submission/File Upload
Your Name

First NameLast Name
Date of Birth

MonthDayYear
Phone Number
Format: (000) 000-0000.
Who at VIP should receive this upload? (If you are a Care Provider, please select "The Care Provider Team")
Do you have a file to upload (preferred method) or would you like to take a picture with your device?
If you have a document you would like to return, click the "Browse Files" button and select the file to upload. You can select multiple files to upload.

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TIPS FOR TAKING A GOOD PHOTO:

Photos must be clear and readable or we cannot process your submission
- Use good lighting
- Hold your phone close so the document fills the screen
- Capture the full document (all 4 corners visible)
- Avoid blurry or dark images
IF YOU ARE SUBMITTING IDENTIFICATION:
- Include both the front and back of your ID card
IF YOU ARE SUBMITTING PROOF OF LOSS OF COVERAGE:
- Include all pages showing your name, reason for loss, and coverage end date
Examples: Use the clear images below as your guide
Click here to take a photo:
Comments
Please verify that you are human
Should be Empty: