Medium

Available on

Apple Android Windows

Athlete's Insurance Information Mobile App

Quickly capture insurance details with this Athlete's Insurance Information app. Includes athlete's information, insurance details, employer information and more. This app can be easily customized to fit your specific needs.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Take a peek inside the Athlete's Insurance Information Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Last Name

  • Ico textbox

    First Name

  • Ico date

    Date of Birth

  • Ico textbox

    Social Security Number

  • Ico dropdown

    Sex

  • Ico dropdown

    Sport(s) - Check all that apply

  • Ico statictext

    INSURANCE INFORMATION

  • Ico textbox

    Insurance Name

  • Ico dropdown

    Insurance Type

  • Ico checkbox

    By checking this box, I certify that I do not currently have medical coverage.

  • Ico textbox

    Insurance Mailing Address - Street Number, Street Name, City, State, Zip Code

  • Ico textbox

    Insurance Phone Number

  • Ico textbox

    Group # (If NO INSURANCE, enter '0')

  • Ico textbox

    Policy # (If NO INSURANCE, enter '0')

  • Ico textbox

    Employer's Name

  • Ico textbox

    Employer's Address - Street Number, Street Name, City, State, Zip Code

  • Ico textbox

    Employer's Phone Number

  • Ico statictext

    Please read the following two (2) checkboxes carefully.

  • Ico statictext

    Should there be any issues with agreeing to the following conditions, please send a message to th...

  • Ico checkbox

    By checking this box, I certify that all information provided above are true, complete and correc...

  • Ico checkbox

    I permit the athletic department to copy and store my medical insurance card under my student ath...

  • Ico statictext

    You must check both boxes.

  • ...and More!

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