Menu
Toggle Menu
Home
Services
Individual Counseling
Residential Counseling for Adult Males
Comprehensive Outpatient Treatment for Adult Men and Women
Group Therapy
Co-occurring Disorder Treatment
AfterCare
Mental Health Referral Services
Court Liaison Assistance
Donations
Re-entry Program
Employment Opportunities
Employment Application
Available Positions
About Us
Blog
Verify Benefits
Contact Us
Home
Services
Individual Counseling
Residential Counseling for Adult Males
Comprehensive Outpatient Treatment for Adult Men and Women
Group Therapy
Co-occurring Disorder Treatment
AfterCare
Mental Health Referral Services
Court Liaison Assistance
Donations
Re-entry Program
Employment Opportunities
Employment Application
Available Positions
About Us
Blog
Insurance Verification Form
Name
(Required)
Email
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
Phone
(Required)
Insurance Company
Type
PPO
HMO
EPO
Other
Member ID Number
Group Number
Insurance Company Phone Number
Have you been to treatment before? If yes, where?
Additional Notes
CAPTCHA
Scroll to Top
