Midwest Recovery Center

Insurance Verification

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Insurance Verification

Dedicated to Excellence

Your Contact Information
Your Name*
First Last
Return Callback Phone Number*
Email*
Who is seeking treatment?*
- Yourself
- A Loved One
How Did You Hear About Us?
Loved Ones Information
Your Information
Loved Ones Name*
First Last
Loved Ones Date Of Birth*
MM slash DD slash YYYY
Your Date Of Birth*
MM slash DD slash YYYY
Additional Information
Insurance Information
Would you like us to verify your or a loved ones insurance benefits?*
- Yes
- No
Policy Holders Name*
First Last
Policy Holders Date Of Birth*
MM slash DD slash YYYY
Policy Holders Address**
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Insurance Company's Name*
Insurance Company's Phone Number*
Member ID*
Group Number*
Subscriber relationship to client*
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Dedicated to Excellence

Start Your Recovery Today

If you or someone you care about is suffering at the hands of addiction or experiencing the mental health issues that often underpin addiction like depression and anxiety, the experienced medical team at Midwest Recovery is ready to take your call.

Insurance Verification

Dedicated to Excellence

Dedicated to Excellence

Your Contact Information

Loved Ones Information

Your Information

Insurance Information

Recovery Begins Here

Midwest Recovery Center

Dedicated to Excellence

Start Your Recovery Today

Recovery
Begins Here