Insurance Verification

Have A Question?

Would you like to learn more about our rehab center and the services we offer? Contact Liberty Bay Recovery Center by filling out the form below. One of our admissions professionals will be in touch with you shortly, or call us at 855-607-8758.

Insurance Information
How did you hear about us?*
Primary Insured Name*
First Last
Primary Insured Date Of Birth*
Month
Day
Year
Primary Insured Address**
Street Address Address Line 2 City State ZIP Code
Insurance Company's Name*
Insurance Company's Phone Number*
Member ID*
Group Number*
Relationship to Primary Insured*
Person Seeking Treatment*
First Last
Date of Birth*
Month
Day
Year
Additional Information
Person of Contact's Name*
First Last
Person of Contact's Phone Number*
Person of Contact's Email*
Liberty Bay will share your insurance information with the appropriate parties to best determine eligibility*
- I consent

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Insurance Information

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