Verify Your Insurance

If you have health insurance, please enter your information below to allow us to do a free verification of benefits to determine your out-of-pocket costs for your stay.  ALL INFORMATION YOU SUBMIT IS CONFIDENTIAL:

Your Name (required)

Your Last Name (required)

Name of Insured (If Different Than Above)

Your Name

Your Last Name

Date of Birth of Person Seeking Treatment


Phone Number (required)

Address, City, State, Zipcode

Insurance Carrier

Type of Plan

Insurance ID#

Phone Number on Back of Card, Marked "Provider" or "Mental Health"

If this is through an employer, please indicate the name of the employer.

Your Message