Insurance Platform Navigator Form

First name*

Last name*

Email*

Phone*

Enter Your Insurance Information

Insurance Provider Name:*

Insurance Policy Number:*

Insurance Type (e.g., PPO, HMO, EAP, Medicaid, Medicare):*

Do you have out-of-network benefits?

Yes

(If yes, please check with your insurance to see how out-of-network therapy sessions are reimbursed.)

Select Your Preferred Platform

SonderMind

Grow Therapy

Headway

Please select the platform(s) you are considering for therapy sessions. We will check if your insurance is accepted by these platforms.

Insurance Credential Verification

To streamline the process, please indicate the platforms you’re considering and if you have verified your insurance coverage.

SonderMind

Accepted?

Yes

Need to verify

Grow Therapy

Accepted?

Yes

Need to verify

Headway

Accepted?

Yes

Need to verify

Once your insurance information is verified, a link will be sent to you to complete the registration process on the platform that works with your insurance.

Please provide your preferred time and platform for your initial consultation:

Preferred Platform:

Preferred Date:

Preferred Time:

Time Zone:

Preferred Method:

Video

Phone

Client Consent

By submitting this form, I consent to sharing my insurance information with the selected therapy platform(s) to check for coverage and eligibility. I understand that once my insurance is verified, a link will be sent to me to complete the registration process and finalize scheduling.

Signature

Signature field is empty.

THRIVENATION@THRIVEFOCUSCOUNSELING.COM

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