Collaborative CBT - Therapy and Consulting
Secure Insurance Card Form
Secure Secondary Insurance Card Form
To request an insurance coverage estimate or to update your insurance information, please complete this form. For general inquiries, complete our contact form. To schedule your first session, complete our scheduling form.
 
As a courtesy, we obtain insurance coverage estimates from insurers. Insurance coverage estimates are subject to change and are not payment guarantees. See our fees and insurance page for more information.
 
You may find it easiest to complete this form on your smartphone as photos of the insurance card are required.
Please acknowledge that emails and text messages should not contain sensitive information. * 🛈
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Please refer to your physical insurance card when populating the remaining fields.
To help prevent billing errors, please upload photos of the front and back of the insurance card (two photo files) below.

What is your relationship to the insurance plan subscriber? *
 
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