Insurance

Whether you’re seeking treatment for yourself or a loved one, we accept most major insurance plans to ensure accessibility to our comprehensive care programs.

Please fill out the form below, and our staff will be in touch with you shortly.

"*" indicates required fields

Patient Name:*

First Last

Patient Phone Number:*

Point of Contact (who should we call back if NOT Patient Name above) :

Point of Contact Phone Number:

Patient Date Of Birth:*

Email Address:*

Primary Insured Address:*

Street Address Address Line 2 City State ZIP Code

Primary Insured Name:*

Primary Insured Phone Number:*

Primary Insured Date Of Birth:*

Insurance Company Name:*

Insurance Company Phone Number for Providers (Mental Health or Substance Abuse):*

ID #:*

Group #:*

Will the patient be getting FMLA Leave while in treatment?*

FMLA refers to the Family and Medical Leave Act, which is a federal law that guarantees certain employees up to 12 workweeks of unpaid leave each year with no threat of job loss. FMLA also requires that employers covered by the law maintain the health benefits for eligible workers just as if they were working.

How did you hear about us?*

captcha

Complimentary Insurance Verification

It is our hope that when you’re ready to take your first step towards recovery, you won’t have to worry about how you’ll cover the costs of your recovery program. We accept most major health insurance plans, and offer complimentary insurance verification.