Insurance Verification

Insurance Verification

Taking the first step towards addiction recovery is often the hardest part of the process. At Melrose Recovery, our addiction specialists strive for the highest quality of care and are here to change lives for the better. Contact Melrose Recovery by calling us at 800-217-3710 or filling out the form below!

Patient Information

First Name: *

Last Name: *

Address: *

Address 2:

City: *

State/Province:

Zip/Postal Code: *

Country: *

Phone: *

Email Address: *

Last Four SSN: *

Date of Birth: *

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Primary Insured Information

Primary Insured First Name: *

Primary Insured Last Name: *

Primary Insured Phone: *

Primary Insured Email: *

Primary Insured Last Four SSN: *

Primary Insured Date of Birth: *

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Insurance Company Information

Insurance Provider Name: *

Insurance ID Number: *

Insurance Group Number: *

Insurance Company Phone: *

Insurance Type: * PPO HMO EPO POS Others

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