After submitting a request, You will be contacted by a member of South Coast Counseling’s insurance utilization review team by telephone or email. We will assist in verifying your insurance information and coverage. Please note that our strict privacy policy keeps your personal information completely safe and secure.

Enter Insurance Information

Client Name*
Member ID*
Group
Insurance Company*
Date Of Birth*
Presenting Problem*

Contact Person Once Verification is Complete


Either an email or primary phone will be required in order to contact you.


Name*
Secondary Phone
Primary Phone*
E-mail