Verify your Benefits!

Fill out the form below to receive an estimation of coverage from your insurance company. 

**Insurance billing for treatment only available for Allied Benefits, Beacon Health Systems, and Blue Cross Blue Shield members.**

Name *
Phone Number *
Phone Number
May I leave a message if I cannot reach you? *
Please select your preferred method of contact:
If your insurance is not in the drop down menu, you may not be covered. Call or email me for further options.
Date of Birth *
Date of Birth
Please enter a brief description of why you are seeking treatment.