The Wellness Room: Insurance Guidance
We realize that working with insurance can seem overwhelming, and at times frustrating. The purpose of this document is to provide guidance in navigating the insurance process. If you are interested in having your sessions covered by your insurance plan, we ask that you complete each step before your first appointment.

The Wellness Room is providing guidance as courtesy to you. The questions and steps on this form are suggestions only, and it is possible that you may need to take steps not referenced on this form in order to obtain necessary information or secure insurance coverage for therapy.

Please Note: We do NOT accept any type of Medicaid or Medicare, supplemental or otherwise.
Client Name *
Your answer
Primary Insurance and Policy Number: *
Your answer
Group Number:
Your answer
Policy Holder Name: *
Your answer
Policy Holder DOB: *
Your answer
Relationship to Client: *
Your answer
Policy Holder Address: *
Your answer
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