Some services and programs may be covered by third party payers including most health insurance companies, based on eligibility.  A diagnostic intake interview is usually required for insurance purposes.  This intake is by appointment.  The following is a partial list of third party payers.  If you carrier is not listed below, please contact our office or your provider to obtain coverage information.

• Advantage

• Blue Cross

• Regence Blue Shield

• Cigna

• First Health

• Humana

• United Behavioral Health Care

These Forms are available for printing in (Adobe .pdf) format or in (Microsoft Word .doc) format.

• Patient Insurance Registration Form (.pdf)
   
• Patient Insurance Registration Form (.doc)

Fax your completed forms to: 1-877-388-1687
or please call 1-877-368-9909 for registration or insurance information.