# Insurance Verification Template
> Insurance Verification template for WordPress with 8 fields. One-click install with FormForge Pro plugin. Verify patient insurance before visit.
- Canonical:
- Last updated: 2026-03-15
- HTML version:
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Agency
8 fields
Industry-Specific
Verify patient insurance before visit.
Patient Name \*
Date of Birth \*
Insurance Company \*
Policy Number \*
Group Number
Primary Subscriber Name
Relationship to Subscriber Select...SelfSpouseChildOther
Upload Insurance Card (front & back)
Click or drag to upload
## Form Fields
| Field | Type | Required |
| --- | --- | --- |
| Patient Name | Text | Required |
| Date of Birth | Date | Required |
| Insurance Company | Text | Required |
| Policy Number | Text | Required |
| Group Number | Text | Optional |
| Primary Subscriber Name | Text | Optional |
| Relationship to Subscriber | Select | Optional |
| Upload Insurance Card (front & back) | File | Optional |
## What’s Included with Agency
Everything in Business, plus:
Industry-Specific Templates
White-Label Branding
Priority Support
Unlimited Sites
Client Management Tools
Custom Integrations
1 Year Updates & Support
## Related Templates
Organizer Name \*
Email Address \*
Phone Number \*
Company / Organization
Event Date \*
Number of Guests \*
Event Type \*Select...Corporate MeetingCelebration / PartyConferenceTeam BuildingOther
Requirements
A/V Equipment Catering Private Room Decorations Reserved Parking
Total Budget Select...Under $1,000$1,000 – $5,000$5,000 – $10,000Over $10,000
Additional Details
Agency
10 fields
### Group Booking
Book for large groups, parties, or corporate events.
[View Template](https://royalplugins.com/formforge/templates/group-booking/)
Guest Name
Email Address
Date of Visit / Stay
Overall Rating \*
★★★★★
Cleanliness
Excellent Good Average Poor
Staff Friendliness
Excellent Good Average Poor
Value for Money
Excellent Good Average Poor
Comments & Suggestions
Would you return?
Definitely Probably Unlikely No
Agency
9 fields
### Guest Feedback
Hotel/restaurant guest satisfaction form.
[View Template](https://royalplugins.com/formforge/templates/guest-feedback-hospitality/)
Full Name \*
Email Address \*
Phone Number \*
Date of Birth \*
Membership Type \*Select...Basic (Gym Only)Premium (Gym + Classes)VIP (All Access)Student
Desired Start Date
Health Conditions / Injuries
Emergency Contact Name \*
Emergency Contact Phone \*
Liability Waiver \*
I accept the terms and liability waiver
Agency
10 fields
### Gym Membership Application
Gym/studio membership registration.
[View Template](https://royalplugins.com/formforge/templates/gym-membership/)
## Use This Template
Get FormForge Agency and start building with the Insurance Verification template today.
[Get FormForge Agency](https://my.royalplugins.com/checkout/?add-to-cart=248)