In Network Request Form

If you would like Luna Medical to become "in-network" for your insurance provider, please submit the form below.

* = required fields

* Insurance Company Name:

* Insurance Claims Address:

* City:

* State:

* Zip Code:

* Insurance Provider Customer Service Phone:

* Insurance Member Customer Service Phone:

Insurance Company

Disclaimer: This website is designed for educational purposes only and is not a substitute for professional care. The information provided here should not be used for diagnosing or treating a health problem or a disease. If you have, or suspect you may have a health problem, you should consult your physician. All medical products require a physician's prescription.