Insurance Verification

Fill out the form below for a FREE insurance verification to see if you are covered for our drug and alcohol treatment services.

First Name

Last Name

Phone Number

First Name

Last Name

Date of birth

Subscriber First Name

Subscriber Last Name

Date of birth

Insurance Name

Policy Number or Member ID Number

Group Number

Insurance Phone Number

1.0. Insurance Card (front side)

1.2. Insurance Card (back side)

2.1. Driver License or State ID Card (front side)

2.2. Driver License Or State ID Card (back side)

Take the First Step Towards Sobriety