New Patient Onboarding — Cognitive Works

1 Review
2 Info & Card
3 Agreement

In order to finalize your appointment, all of the steps below must be completed.

A valid credit or debit card is required to complete onboarding. A temporary $100 hold (not a charge) will verify your card and is released immediately.

Have your insurance card images ready (front & back) — you will upload them as part of the patient agreement. If you are paying out of pocket, insurance cards are not required.

After card verification, you will complete a patient agreement through BoldSign, a secure electronic signature platform, to finalize your onboarding.

I have read and understand the above requirements

Patient Information & Card Verification

Complete each section below to proceed.

Patient Information
Enter the patient's details
Confirmed A
Required
Required
Enter a 10-digit US phone number
Please check your email — the domain or TLD looks like it may have a typo. If your address is legitimately being rejected, call 952-300-6277.
Edit
Credit Card Verification
Cardholder may differ from patient
VISA MC AMEX DISC
B
Card entry is hosted and encrypted by TrustCommerce
Important: the "Keep my card on file" box in the form below must remain checked — it is required to complete onboarding.
The secure card form will open here after you confirm your information above.

Your card details are entered directly on TrustCommerce’s secure servers. Cognitive Works never sees or stores your card number.

Card verified
Your card was accepted. Continue to the patient agreement.
Use a different card

Please wait... verifying your card. Do not close or refresh this page.

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