Verify Insurance Coverage

We work with a number of different US insurance providers.
Verify your insurance eligibility by completing our insurance verification form, which kick-starts our health insurance verification process and takes only a few minutes.

Don’t worry, it’s free, completely confidential and there is never any obligation.

Call us at 877-929-5105
or if dialing from outside the US, +1-714-798-9320

Required

Patient Full Legal Name

First Name

Last Name

Insurance Company Name

Insurance Company Phone Number

Patient Insurance Member ID

Primary Subscriber Full Legal Name

First Name

Last Name

Primary Subscriber Current Address

Street Address

Address Line 2

City

State

Postal / Zip Code

Country

Primary Subscriber Phone Number

Person Completing This Form

First Name

Last Name

Phone Number

This is the telephone number where we will call you.

Email Address

We will never share your private email address. Learn More.

I agree to the Terms of Use and Privacy Policy

Upon receipt of your insurance verification, our admissions specialists will verify specific information from you by phone prior to submitting your form for verification.