Insurance Verification Form

Verify Your Insurance

Please fill out the form below, and we will be in touch with you shortly. Thank you.

Patient Name:*
First Last
Patient Phone Number:*
Point of Contact (who should we call back if NOT Patient Name above) :
Point of Contact Phone Number:
Patient Date Of Birth:*
Month
Day
Year
Email Address:*
Primary Insured Address:*
Street Address Address Line 2 City State ZIP Code
Primary Insured Name:*
Primary Insured Phone Number:*
Primary Insured Date Of Birth:*
Month
Day
Year
Insurance Company Name:*
Insurance Company Phone Number for Providers (Mental Health or Substance Abuse):*
ID #:*
Group #:*
Will the patient be getting FMLA Leave while in treatment?*
FMLA refers to the Family and Medical Leave Act, which is a federal law that guarantees certain employees up to 12 workweeks of unpaid leave each year with no threat of job loss. FMLA also requires that employers covered by the law maintain the health benefits for eligible workers just as if they were working.
How did you hear about us?*
Please specify:*

Most Major Insurance Accepted

"I went through inpatient treatment and sober living at RDT and it saved my life, helped improve my mental health, and has done many miracles in all areas of my life including giving me a future I wasn’t sure i was going to have. I’m beyond thankful and blessed for this facility and program.”

Carson

“This place gave me a new life today!

They teach you the tools that will last a lifetime.”

Nancy

"I have almost 15 months of sobriety and it’s because the tools I have learned from Dove Tree that made it possible.”

Warren

“[My counselor] was so down-to-earth and easy to open up to.”

Former Client

“Well maintained and well run! The staff was caring because a lot were also in recovery themselves!”

Jeremy