Insurance Verification | Steps to Recovery

Want to begin treatment at Steps to Recovery? Have questions about insurance? Use the below insurance verification form to beign the admissions process. You can also contact Steps to Recovery today at 866-488-8684.

Step 1 of 3

Patient Information
Name*
First Last
Patient Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Patient Phone*
Patient Email*
Patient Date of Birth*
MM slash DD slash YYYY

Primary Insured Information
Primary Insured Full Name*
First Last
Primary Insured DOB*
MM slash DD slash YYYY
Primary Insured Phone Number*
Primary Insured Email Address*

INSURANCE COMPANY INFORMATION
Insurance Provider Name*
Insurance ID Number*
Insurance Group Number*
Insurance Company Phone #*
Insurance Type*
How Did you Hear About Us
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Step 1 of 3

Patient Information

Primary Insured Information

INSURANCE COMPANY INFORMATION

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