In compliance with HIPPA Privacy Regulations regulations governed by U.S. Department of Health & Human Services, we may only contact you regarding confidential health matters in ways that you explicitly authorize. By providing the above contact information, you are authorizing us to contact you via that method. The more ways we have to contact you, the more quickly you can get your answer.
For your privacy, select the method least likely to be checked by other parties. By submitting this form, you are explicitly authorizing us to use the information supplied to contact your insurance provider for the purpose of verifying eligibility for insurance benefits for the purposes stated above. The above information will also be used by an Admissions Counselor at Sober Partners to provide you with treatment options.
Under no circumstances will your confidential information be shared with third parties or used for any purpose other than stated herein.