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Medical Insurance Update Form

  1. Please use this form to update medical insurance information for the minor child(ren)
  2. **Disclaimer**: As this website is a third-party entity, the Friend of the Court is unable to ensure that ANY documents uploaded to this website will be secure. If you do not wish to upload any or all of the requested documentation through this website, then you may provide the Friend of the Court with the requested documentation through one of the following means:
  3. Mail to: 100 East State Street, Suite 4100, St Johns MI 48879
  4. Fax to: 989-224-5113
  5. You may also call the Friend of the Court at 989-224-5136 if you have any questions about returning your documents.
  6. Do you, or does anyone in your household maintain health insurance for your mionr child/ren?*
  7. Is this insurance Medicaid or other State insurance?
  8. Is this insurance provided through an employer?
  9. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  10. Leave This Blank:

  11. This field is not part of the form submission.