Health Insurance Verification Form

Our secure online health insurance verification is free and easy to use. We will provide you with a total cost of care with health insurance. For more information about how we work with insurance, visit our insurance we accept page.

Name *

First

Last

Date of Birth *//

Name of Insurance Company *

Please note: we cannot accept Medicaid or Medicare from any state.

Member ID *

Typically located on the front of the card.

Phone Number *

Tranquility Woods

Health Insurance Verification Form

Unfortunately, we are unable to accept medicare or Medicaid from any state. Please visit findtreatment.gov for the complete list of providers that can accept your insurance.

Tranquility Woods