Verify your insurance

If you have

PPO coverage
from a major insurance provider, your treatment may be covered.

We are unable to accept

Medi-cal, medicare, Medicade, Tricare, Kaiser, Healthnet or Humana at this time

We value your privacy.
All treatment inquiries and personal information is always
kept confidential.

Confidential Insurance Benefits Verification Form

1Tell us about yourself

Full Name

Date of Birth

E-Mail Address

Phone Number

2How would you like to get your Insurance card to us?

I'll take/upload a picture of my card. I'll enter my card info below

Insurance Card - (Front Side)

Insurance Card - (Back Side)

Insurance Card Provider

Member ID#

Customer Service Phone # (Back of Card)

3Briefly describe what substances you're struggling with or what condition you would like to treat. and if you've ever been in treatment before. Also here you can describe any of the questions you might have.