To take your first step towards recovery, complete the insurance verification form below. Huntington Beach Detox accepts most private insurance plans. If you have any questions about insurance coverage and treatment, please call us today at (855) 790-7418.
Patient Information
Primary Insured Information
Insurance Company Information
Patient Information
Primary Insured Information
Insurance Company Information
Name
First Name
Last Name
Patient Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Patient Info
Patient Phone
Patient Email
Patient Last Four SSN
Patient Date of Birth
Primary Insured Name
First Name
Last Name
Primary Insured Info
Primary Insured DOB
Primary Insured Last Four SSN
Primary Insured Phone Number
Primary Insured Email Address
Insurance Info
Insurance Provider Name
Insurance ID Number
Insurance Group Number
Insurance Company Phone
Insurance Type
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