To bill insurance for your therapeutic services we need to verify your insurance coverage before your first appointment. Please provide your insurance information using the form below before booking your first appointment to confirm your coverage and copay amount.
Without pre-authorization of your insurance, you will be required to pay in full for your first appointment.
The information obtained below is necessary to complete claims under insurance programs, is used to determine your eligibility and if services we provide are covered by your insurance. By filling out this form you authorize the release of any medical information necessary to process this eligibility request.