Insurance Verification

We accept most major insurance providers.

Please provide your insurance information in the form below and a member of our team will reach back out to you!

This field is for validation purposes and should be left unchanged.

Legal Name(Required)

First Last

Preferred Name

(optional)

Parent Phone(Required)

Parent Email(Required)

Prospective Client Date of Birth(Required)

Address on file with Insurance Carrier(Required)

Street Address City State / Province / Region ZIP / Postal Code

Insurance Carrier(Required)

Group Number(Required)

ID#(Required)

Insurance provider phone number, for mental health benefits (if applicable)

Insurance Subscriber Name(Required)

First Last

Insurance Subscriber Date of Birth(Required)

Insurance subscribers relationship to prospective client(Required)

Briefly describe your reason for seeking mental health support

CAPTCHA