Insurance

Let's Check Your Coverage. No Commitment Required.

Share a few details and our team will verify your benefits and follow up within one business day.

First Name *

Last Name *

Date of Birth *

Phone *

Email *

Insurance Provider *

Insurance Member ID (if you have it available)

Group Number (optional)

How would you like to be contacted? *

Phone call

Text message

Best time to reach you *

Morning

Afternoon

Evening

No preference

Yes, I consent to receive text messages from Primary Behavioral Health at the phone number provided. Message types may include appointment reminders, intake follow-up, and general health and wellness information. Message and data rates may apply. Message frequency varies. Reply STOP to opt out at any time. Reply HELP for assistance.

This form is for insurance verification only and does not establish a therapeutic relationship. We will contact you within one business day to discuss your coverage. Your information is protected under HIPAA. For emergencies, call 911 or the 988 Suicide and Crisis Lifeline.