[bt_section layout=”boxed” top_spaced=”topSemiSpaced” bottom_spaced=”bottomSemiSpaced” skin=”dark” full_screen=”no” vertical_align=”inherit” divider=”no” back_image=”35″ back_color=”#444444″ back_video=”” video_settings=”” parallax=”” parallax_offset=”” animation=”” animation_back=”” animation_impress=”” el_id=”” el_class=”” el_style=””][bt_row][bt_column width=”1/1″][bt_hr top_spaced=”topExtraSmallSpaced” bottom_spaced=”bottomExtraSmallSpaced” transparent_border=”noBorder” el_class=”” el_style=””][/bt_hr][bt_hr top_spaced=”topExtraSmallSpaced” bottom_spaced=”bottomExtraSmallSpaced” transparent_border=”noBorder” el_class=”” el_style=””][/bt_hr][bt_header superheadline=”Verify Your Insurance: Take the Second Step” headline=”Please Fill Out the Form Below” headline_size=”large” dash=”no” dash_style=”btNormalDash” subheadline=”” el_class=”” el_style=””][/bt_header][/bt_column][/bt_row][/bt_section][bt_section][bt_row][bt_column width=”1/1″ align=”left” vertical_align=”inherit” border=”no_border” cell_padding=”default” animation=”animate animate-fadein animate-moveup” text_indent=”no_text_indent” highlight=”no_highlight” background_color=”” opacity=”” inner_background_color=”” background_image=”” el_class=”” el_style=””][bt_hr top_spaced=”topSmallSpaced” bottom_spaced=”bottomSmallSpaced” transparent_border=”noBorder” el_class=”” el_style=””][/bt_hr][bt_hr top_spaced=”topSmallSpaced” bottom_spaced=”bottomSmallSpaced” transparent_border=”noBorder” el_class=”” el_style=””][/bt_hr][bt_header superheadline=”Easily Verify Your Insurance” headline=”DEDICATED TO HELPING YOU GET THE BEST CARE POSSIBLE” headline_size=”large” dash=”top” dash_style=”btAccentDash” subheadline=”” el_class=”” el_style=”margin-bottom: 5%;”][/bt_header][bt_text][gravityform id=5 title=false description=false ajax=true tabindex=49][/bt_text][bt_hr top_spaced=”topSmallSpaced” bottom_spaced=”bottomSmallSpaced” transparent_border=”noBorder” el_class=”” el_style=””][/bt_hr][/bt_column][/bt_row][/bt_section]