Insurance Verification Form

Don’t let financial reasons stop you from seeking the help you need.At Sober Living Orange County, it is our goal to provide you with quality care at a price you and your family can afford. Please fill in the form and submit it for review. We’ll check your coverage as soon as possible and have a StepHouse Recovery intake specialist call you and explain what your options are.

*All information is confidential and will not be shared with third parties.

Patient Information


Your Full Name *

D.O.B. *


Social Security Number

Subscriber Name *

Contact Information


Phone Number *

Your Email *



Street Address *

City *

State *

Zip Code *

Insurance Information


Insurance Company *

Insurance Phone Nunmber

Subscriber's Name *

Subscriber's D.O.B

Subscriber's Social Security Number

Subscriber's Phone Number

ID Number

Group Number *

Plan Type

Get Social


10537 Slater Avenue
Fountain Valley, CA 92708

StepHouse Recovery

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