Instructions for Applying with Private Insurance

Step 1Click here to access the Private Insurance Application. Please complete the application online, then print off to include your signature.
Access Private Insurance Application
Step 2Request a prescription from your doctor. If you are unable to visit your doctor to obtain a prescription, please include your doctor’s name, address and phone number on the Private Insurance Application and we will work with your doctor to obtain your prescription – which saves you a doctor’s visit!
Step 3Send your signed completed application to Bonro Medical®. Remember to include your doctor’s prescription or contact information. After receiving your application we will handle the rest!

3 Ways to Submit Your Application:

Fax Your Application To:
Mail Your Application To:
Bonro Medical
P.O. Box 1880
Evans, GA 30809
If You Have a Scanner
Email Your Completed Application to
*You will need to scan in your signed completed application and the front & back of your insurance cards.


Give us a call and we’ll be happy to answer any questions you may have!
1-877-266-7699 Toll-Free • 706-210-4747 Local