We are here to help you and a loved one struggling with addiction. By filling out this form we can help verify your insurance as well as determine what out of pocket expenses.
Please call (619) 870-1334with any questions you may have.
Patient Date of Birth
Last Four Digits of SSN
Type of Plan
Have you been to treatment before?
Brief Description of Your Addiction
2236 Encinitas Blvd Suite D, Encinitas, CA 92024
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