Shopping Cart
Your Cart is Empty
Quantity: Remove
Subtotal
Taxes
Shipping
Total
There was an error with PayPalClick here to try again
CelebrateThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping Cart

Verify your Insurance Benefits


Please fill out all information in the form in its entirety in order for our specialized insurance team to verify your benefits accurately. 


We accept most insurance plans and Employee Assistance Programs (EAP's) 

(MM/DD/YYYY)
Example: Cigna, Aetna, United Health Care, Etc
Please include your Member ID as printed on your Insurance Card
Preferred Contact Method*
Please include your phone number so we may contact you with your insurance benefits
Please provide an email address
This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Thank you! Your form was sent successfully.
/
Lightbox image