Insurance Benefits for Treatment | Turning Point of Tampa

Please fill out the form below so we can verify your insurance information.

Treatment Options
Treatment for:*
Type of Treatment*
- Alcohol
- Drugs
- Eating Disorder
Contact Information
Contact Name*
First Last
Contact Phone*
Contact Email Address*
Enter Email Confirm Email
Contact Employer
Contact Relationship to Patient
Patient Full Name*
Patient Date of Birth*
Date Format: MM slash DD slash YYYY
Patient Full Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Insurance Information
Patient Insurance Company Name*
Member ID / Policy Number*
Insurance Customer Service Number*
Name of Primary Insurance Policy Holder*
Policy Holder Date of Birth*
Date Format: MM slash DD slash YYYY
Does Patient Have Other Insurance?*
- Yes
- No
Other Insurance Company Name*
Other Insurance Member ID / Policy Number*
Comments
This field is for validation purposes and should be left unchanged.

Verify Insurance Benefits