VERIFICATION OF BENEFITS

To Verify your benefits for our programs, click the link below and fill out the questions online.

Scroll Down for the Information you will need to complete the form. 

On weekdays Verification can take up to 24 hours, If you happen to be contacting us on a weekend, please allow us until Monday to respond to your inquiry.

Collect this information before filling out this online VOB

Client Information:

Patient Name *

• First Name*
• Last Name*
• Patient date of birth *
• Secondary Insurance or Additional Notes
• ​Patient phone number
• ​Client last 4 digits of SSN*
• ​Client Address
• Insurance Provider *
• ​Insurance Provider Phone *
• ​Client Insurance ID *
• ​First Name of Policy Holder
• ​Last Name of Policy Holder
• Policy Holder's Date of Birth
• Client's relationship to policy holder *

                 (Self, Spouse, Child, Dependent)

• Policy holder address
• ​Report policy benefits for: *

                 (Substance Abuse, Mental Health)

• Type of benefit *

                 (Out of network / In network)