Insurance Verification

Start Your Wellness Journey Verify Your Insurance Information

We accept select insurance providers at Defining Wellness Centers. Fill out the form below and we will verify your insurance to see if we are the right fit. If you have any further questions please feel free to contact one of our admissions staff members at
Begin your Recovery Today
(855) 790-9303.

Primary Contact Information
Your Name*
First Last
Your Email*
Your Phone Number:*
Patient Information
Patient Name*
Patient Date of Birth*
Patient Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Policy Holder's Information
Policy Holder Name & Relationship:*
Policy Holder's Date of Birth:*
Last 4 Digits of SSN#*
Policy Holder's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Insurance Information
Insurance Provider*
Insurance Phone Number*
Insurance ID Number*
Insurance Group Number*
Type of Plan*
Comments*
Comments
This field is for validation purposes and should be left unchanged.

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