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


10517 Slater Avenue
Fountain Valley, CA 92708

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