I authorize Serenity-BHS to check benefits on behalf of the client seeking counseling.
I authorize the release of any information necessary to process claims with my insurance company and I authorize my insurance company to make payments for my treatment directly Serenity Behavioral Health Services. I understand that I am responsible for paying my deductible or co-pay (where applicable). I agree to pay the cost of each session.
Primary Insured Member Information:
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Please complete the following information in order for our billing department to check your Health Insurance Benefits prior to your first appointment.
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