Insurance Verification Form

Clients who wish to bill therapy sessions through their insurance must complete this verification form prior to their first Three Oaks appointment. Please visit our [FAQ page] to learn more!

*Please note: To avoid response time delays, please ensure you indicate the name of your Three Oaks provider on the form below.

For insurance related questions, please email our Billing Team:
clients@threeoaksbehavioralhealth.com

Please choose one.
What is the name of your Three Oaks therapist? If you have not yet been connected with a therapist on our team, please first submit a contact form. We look forward to welcoming you to the practice!
Must match the name listed with insurance.
We recognize and honor that many of our clients identify by names other than their current legal name and know, express, and/or identify their gender in a non-binary way.
Must match the sex listed with insurance. (Gender selection for insurance claim forms only includes male or female, binary options.)
How will you be meeting with your therapist?
Please select all that apply.

Documents Needed to Complete Verification

Before uploading an additional document, please verify that the document's name and file size appear in the box.
Click or drag a file to this area to upload.
Please upload a photo of your government issued ID (for example, driver’s license or passport).
Click or drag a file to this area to upload.
Please upload a photo of the FRONT of your insurance card.
Click or drag a file to this area to upload.
Please upload a photo of the BACK of your insurance card.
Three Oaks only files with primary coverage. Clients with secondary or out of network insurance will be provided with a Superbill for possible reimbursement.