If you are using Insurance please enter the following information in the box below:
Insurance Company Name
Insurance ID #
Your Workplace
Please call your insurance company to be sure you're covered under "Specialist" services. Also check your co-pay and deductible. This will help avoid potential problems later.
If you are using Employee Assistance Program behefits please enter the following information in the box below:
Name of EAP (Value Options, Cigna, etc)
EAP Authorization #
Number of sessions
Dates that sessions are valid
Your Workplace