Insurance Verification Form

For new clients and current clients.

We like to verify your insurance at least 3 days (72 hours) prior to your appointment. This allows us to know what your portion is before you come in so that there are no surprises.

If you are a current client and your insurance has changed, you may input your information for us to reverify.

If you will be using an EAP (Employee Assistance Program) we will still need your insurance information as well as your EAP Authorization information PRIOR to you appointment. If we do not receive your EAP Authorization number or your Insurance information before your appointment, you will be responsible for the cash price of the session. Please call us with any questions. (713) 365-0700 x-302.

Please fill out all sections of the form.

Thank you so much for all you do!
~Renewing Hope Staff~

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