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Will you be in the state of Colorado when attending appointments?
Yes
No
Please select an option.
What Is The Client’s Legal First And Last Name (As Listed with Insurance)?
First Name
Last Name
What is the contact email address?
Email Address
This field is required.
What is the client’s date of birth?
Date of birth
This field is required.
Are You a Current or Previous Client?
Yes
No
Please select an option.
Are you looking to use insurance for services?
Yes
No
Please selec at least one option
What is the client’s primary insurance member ID number?
Insurance Member ID
This field is required.
Select Your Primary Insurance Plan: (choose the closest option below and we will notify you if we need more information)
Aetna
Aetna Medicare Advantage
All Savers Insurance
Anthem/Blue Cross Blue Shield/Federal BCBS (IN ANY STATE)
Beacon/Carelon
Anthem BCBS Medicare Advantage
Cigna
Cigna Medicare Advantage/Health Springs
Denver Health Medical Plans/First Health
First Health
Humana
Kaiser Permanente HMO
Medicaid-Health First Colorado and CHP+
Medicare
Medicare Dual Enrollment (Medicare with Medicaid)
Oscar Health
Oxford Health Plans
PHCS/Multiplan
Rocky Mountain Health Plans
SelectHealth
SelectHealth Medicare Advantage
UHC Student Resources
UMR
United Healthcare
United Medicare Advantage
Other Insurance Plan
Add Insurance Plan
1199 NATIONAL BENEFIT FUND
90 DEGREE BENEFITS
AARP
ACS BENEFIT SERVICES
ADMINISTRATIVE CONCEPTS INC.
ADVANTEK BENEFIT ADMINISTRATORS
AETNA
ALL SAVERS INSURANCE
ALLEGEANT
ALLIANT HEALTH PLANS
ALLIED BENEFITS SYSTEMS INC.
ALLIED BENEFITS-BO
ALLIED TRADES
ALOHACARE
AMBETTER
AMERICAN MEDICAL SECURITY AMS
AMERICAN NATIONAL INSURANCE COMPANY
AMERIGROUP
AMERIHEALTH ADMINISTRATORS INC.
AMERIHEALTH CARITAS FLORIDA
AMERIHEALTH CARITAS LOUISIANA (LACARE)
AMERIHEALTH CARITAS NEXT NORTH CAROLINA
AMERIHEALTH CARITAS NORTH CAROLINA
AMERIHEALTH CARITAS NORTHEAST (AMERIHEALTH NORTHEAST)
AMERIHEALTH CARITAS PENNSYLVANIA
AMERIHEALTH CARITAS PENNSYLVANIA COMMUNITY HEALTHCHOICE
AMERIHEALTH CARITAS VIP CARE
AMERIHEALTH DELAWARE
AMERIHEALTH DISTRICT OF COLUMBIA
AMERIHEALTH HMO NJ AND DE
AMERIHEALTH NJ
AMERIHEALTH NORTHEAST
ANTHEM BLUE CROSS CALIFORNIA
ANTHEM Rx
APEX BENEFIT SERVICES
APS HEALTHCARE INC AMERICAN PSYCH SYSTEMS
APWU HEALTH PLAN
ASSURANT HEALTH SELF FUNDED
ASSURED BENEFIT ADMINISTRATORS
ASURIS
ASURIS NORTHWEST
AULTCARE OF OHIO
AVANTE
AVANTE HEALTH
AVMED INC
Aetna Pharmacy
Allways Health Partners
BAPTIST HEALTH PLAN
BCBS CAREFIRST
BCBS FEDERAL
BCBS of AK
BCBS of AL
BCBS of AR
BCBS of AZ
BCBS of CA
BCBS of CO
BCBS of CT
BCBS of DE
BCBS of FL
BCBS of GA
BCBS of HI
BCBS of IA
BCBS of ID
BCBS of IL
BCBS of IN
BCBS of KS
BCBS of KY
BCBS of LA
BCBS of MA
BCBS of MD
BCBS of ME
BCBS of MI
BCBS of MN
BCBS of MO
BCBS of MS
BCBS of MT
BCBS of NC
BCBS of ND
BCBS of NE
BCBS of NH
BCBS of NJ
BCBS of NM
BCBS of NV
BCBS of NY
BCBS of OH
BCBS of OK
BCBS of OR
BCBS of PA
BCBS of RI
BCBS of SC
BCBS of SD
BCBS of TN
BCBS of TX
BCBS of UT
BCBS of VA
BCBS of VT
BCBS of WA
BCBS of WI
BCBS of WV
BCBS of WY
BEACON HEALTH OPTIONS
BEACON HEALTH STRATEGIES
BEHAVIORAL HEALTH SYSTEMS
BENEFIT ADMINISTRATIVE SYSTEMS LLC
BIND HEALTHCARE
BLUE CROSS BLUE SHIELD
BLUE GRASS FAMILY HEALTH
BLUE SHIELD of CA
BOON CHAPMAN ADMINSTRATORS INC
BRIGHT HEALTHCARE
BUCKEYE COMMUNITY HEALTH
Blue Cross Blue Shield Maryland (Carefirst)
CAPITAL BCBS
CAPITAL DISTRICT PHYSICIANS HEALTH PLAN-CDPHP
CAREFIRST ADMINISTRATORS
CAREFIRST NETWORK LEASING
CARELON BEHAVIORAL HEALTH
CARESOURCE
CBA BLUE
CCSTPA
CENTRAL PENNSYLVANIA TEAMSTERS
CHAMPVA - HAC
CHRISTUS HEALTH PLAN TEXAS HIX
CIGNA
COLORADO MEDICAID
COMMUNITY CARE MGD. HLTHCARE PLANS
COMMUNITY HEALTH CHOICE TX - HIM
COMPANION LIFE
COMPSYCH
CONSOLIDATED HEALTH PLANS
CONSTRUCTION WORKERS TRUST FUND
CORESOURCE
COVENTRY HEALTH CARE
CUSTOM DESIGN BENEFITS INC.
CVS Caremark
CWI BENEFITS INC.
CYPRESS BENEFIT ADMINISTATORS
Caremark
Cigna Tel Drug
CitizenRx
DENVER HEALTH MEDICAL PLAN
EBAM
EDS HEALTHCHOICE OF OK
EMBLEM HEALTH
EMI HEALTH
EMPIRE BCBS
EMPLOYEE BENEFIT MGMT SERVICE
EMPLOYERS INS COMP OF NEVADA
ENTRUST
EVOLUTION
EXCELLUS BCBS
EXPRESS SCRIPTS
EnvisionRx
FIDELIS CARE OF NY
FIRST HEALTH NETWORK
FIRSTCARE
FLORIDA MEDICAID
FMH BENEFIT SERVICES INC.
FRIDAY HEALTH PLANS of CO
GATEWAY HEALTH PLAN
GEHA
GEISINGER HEALTH PLAN
GENERAL LABORS UNION LOCAL UNION 472
GHI
GLOBAL CARE
GLOBAL HEALTH OKC
GOLDEN RULE
GOVERNMENT EMPLOYEE HOSPITAL ASSOC GEHA
GROUP AND PENSION ADMINISTRATORS
GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI
GULF GUARANTEE
HARKEN HEALTH
HARTLAND
HARVARD PILGRAM
HAWAII MEDICAID
HEALTH ADMINISTRATIVE SERVICE INC
HEALTH ALLIANCE PLAN
HEALTH EQUITY, INC
HEALTH FIRST HEALTH PLAN
HEALTH NET
HEALTH PARTNERS
HEALTH PARTNERS NORTH
HEALTH PLAN ADMINISTRATORS
HEALTH SCOPE BENEFITS
HEALTH SELECT OF TX
HEALTH SPAN
HEALTHCARE STRATEGIES
HEALTHCHOICE
HEALTHFIRST OF NEW YORK
HEALTHGRAM
HEALTHNET FEDERAL SERVICES
HEALTHSMART
HEARTLAND
HIGHMARK BCBS
HMA - Hawaii Mainland Administrators
HMAA - Hawaii Medical Assurance Association
HMC HEALTHWORKS
HMSA - Hawaii Medical Service Association
HOMETOWN HEALTH PLAN NEVADA
HORIZON BLUE CROSSBLUE SHIELD OF NEW JERSEY
HUMANA
HUMANA CARESOURCE OF KENTUCKY
HUMANA MEDICARE
Healthkeepers
Humana Pharmacy
IHC HEALTH SOLUTIONS
IHS CLAIMS
INDEPENDENCE ADMINISTRATORS
INDEPENDENT HEALTH
INETICO INC.
INFORMED LLC
INGENIO Rx
INSURANCE MANAGEMENT SERVICES
INTEGRA GROUP
IngenioRx
JOHN HOPKINS HEALTHCARE
JOHNS HOPKINS MEDICAL SERVICE
K G ADMINISTRATORS SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII
KAISER PERMANENTE
KERN PPO - CALIFORNIA
KEYSTONE FIRST COMMUNITY HEALTH PLAN
KPIC
KPP
Kaiser Foundation Health Plan of Colorado
Kroger Pharmacy
LAKESIDE COMMUNITY HEALTHCARE
LIFESHIELD NATIONAL
LIFESTYLES HEALTH
LINECO
MAGELLAN
MAGNACARE
MAIL HANDLERS BENEFIT PLAN
MANAGED HEALTH NETWORK
MANAGED HEALTH NETWORK (MHN)
MARYLAND BLUE CROSS - CAREFIRST
MAXOR ADMINISTRATIVE SERVICES
MAYO CLINIC
MCGREGOR AND ASSOCIATES
MED CENTER HEALTH
MED PARTNERS
MEDBEN
MEDCOST BENEFIT SERVICES MBS
MEDICA IFB
MEDICA2
MEDICAL BENEFITS ADMINISTRATORS NEWARK OHIO
MEDICAL MUTUAL OF OHIO
MEDICARE PART A
MEDPARTNERS
MEDSTAR HEALTH PLAN
MEMORIAL HEALTHCARE SYSTEM
MEMORIAL HERMAN
MENTAL HEALTH CONSULTANTS
MERIDIAN HEALTH PLAN
MERITAIN HEALTH
MERITAIN HEALTH MINNEAPOLIS
MODA HEALTH PLAN
MOLINA HEALTHCARE of CA
MOLINA HEALTHCARE of FL
MOLINA HEALTHCARE of UT
MVP HEALTH PLANS
Maryland Medicaid
Mass General Brigham Health Plan
Med-Impact
Medicare Part B
Michigan Medicaid
Molina Complete Care of Virginia
Molina Healthcare of Texas
NATIONAL ELEVATOR INC.
NEW YORK GROUP HEALTH
NEX CALIBER
NGS AMERICAN INC.
NORTH AMERICAN ADMINISTRATORS
NORTHEAST GEORGIA HEALTH SERVICES
OHANA HEALTH PLAN (WELLCARE OF HAWAII)
OPTIMA
OPTIMA/SENTARA
OPTUM
OXFORD HEALTH PLANS
OptumRx
Oscar Health
PAI
PAN-AMERICAN LIFE INSURANCE
PARAMOUNT HEALTH
PARAMOUNT HEALTH CARE
PENN BEHAVIORAL HEALTH
PHILADELPHIA AMERICAN LIFE INS CO
PHILADELPHIA AMERICAN PHCS
PIEDMONT BEHAVIORAL HEALTH
PIEDMONT COMMUNITY HEALTH INSURANCE
PLANNED ADMINISTRATORS INC.
POMCO
PREFERRED ONE
PREMERA
PRESBYTERIAN HEALTH
PRIMARY PHYSICIANCARE INC.
PRIORITY HEALTH OF MICHIGAN
PRUDENT BUYER PLAN
PUBLIC EMPLOYEE HEALTH PLAN PEHP
Prime Therapeutics
QUALCARE
QUALCARE DBA QANI ADMINISTRATORS
QUALCHOICE
QUALCHOICE OF ARKANSAS
QUEST BH
RURL CARRIER BENEFIT
SANA BENEFITS
SANFORD HEALTH PLAN
SCOTT AND WHITE HEALTH PLAN
SECURITY HEALTH PLAN
SEDGWICK CLAIMS
SELECT BENEFIT ADMINISTRATORS
SELECT HEALTH OF UTAH
SELECTHEALTH OF SC
SEMINOLE TRIBE OF FLORIDA
SIERRA HEALTH SERVICES
ST MARYS HEATLH PLAN
SUMMACARE HEALTH PLAN
Scott & White Rx
TEAMSTERS
THE HARTFORD
THE LOOMIS COMPANY
TML MULTI STATE
TOTAL CARE NETWORK
TRICARE - EAST
TRICARE - WEST
TRICARE FOR LIFE
TRISTAR BENEFIT ADMINISTRATORS TPA
TRUSTEED PLANS SERVICE CORPORATION
TRUSTMARK
TUFTS HEALTH PLAN
True Scripts
UHC SHARED SERVICES
UHC STUDENT RESOURCES
UMR
UNI
UNITED HEALTHCARE
UNIVERSITY OF UTAH HEALTH PLANS
UPMC HEALTH PLAN COMMERCIAL
US Family Health Plan
USAA
UTAH MEDICAID
University of Iowa Rx
VIRGINIA MEDICAID
VIVA Health
Vantage Health
Virginia Medicaid
WEB TPA
WELLCARE HEALTH PLANS
ZELIS PREFERRED
ZELLUS HEALTH SOLUTIONS
Please selec at least one option
Submit
Do you have a secondary insurance plan?
Yes
No
Please selec at least one option
What is the member ID for the client’s secondary insurance plan?
Member ID
This field is required.
What insurance payer is secondary insurance plan? (choose the closest option below and we will notify you if we need more information)
Aetna
Aetna Medicare Advantage
All Savers Insurance
Anthem BCBS Medicare Advantage
Anthem/Blue Cross Blue Shield/Federal BCBS (IN ANY STATE)
Beacon/Carelon
Cigna
Cigna Medicare Advantage/Health Springs
Denver Health Medical Plans/First Health
First Health
Humana
Kaiser Permanente
Medicaid-Health First Colorado and CHP+
Oscar Health
Oxford Health Plans
PHCS/Multiplan
Rocky Mountain Commercial
SelectHealth
SelectHealth Medicare Advantage
UHC Student Resources
UMR
United Healthcare
United Medicare Advantage
Other Insurance Plan
Add Insurance Plan
1199 NATIONAL BENEFIT FUND
90 DEGREE BENEFITS
AARP
ACS BENEFIT SERVICES
ADMINISTRATIVE CONCEPTS INC.
ADVANTEK BENEFIT ADMINISTRATORS
AETNA
ALL SAVERS INSURANCE
ALLEGEANT
ALLIANT HEALTH PLANS
ALLIED BENEFITS SYSTEMS INC.
ALLIED BENEFITS-BO
ALLIED TRADES
ALOHACARE
AMBETTER
AMERICAN MEDICAL SECURITY AMS
AMERICAN NATIONAL INSURANCE COMPANY
AMERIGROUP
AMERIHEALTH ADMINISTRATORS INC.
AMERIHEALTH CARITAS FLORIDA
AMERIHEALTH CARITAS LOUISIANA (LACARE)
AMERIHEALTH CARITAS NEXT NORTH CAROLINA
AMERIHEALTH CARITAS NORTH CAROLINA
AMERIHEALTH CARITAS NORTHEAST (AMERIHEALTH NORTHEAST)
AMERIHEALTH CARITAS PENNSYLVANIA
AMERIHEALTH CARITAS PENNSYLVANIA COMMUNITY HEALTHCHOICE
AMERIHEALTH CARITAS VIP CARE
AMERIHEALTH DELAWARE
AMERIHEALTH DISTRICT OF COLUMBIA
AMERIHEALTH HMO NJ AND DE
AMERIHEALTH NJ
AMERIHEALTH NORTHEAST
ANTHEM BLUE CROSS CALIFORNIA
ANTHEM Rx
APEX BENEFIT SERVICES
APS HEALTHCARE INC AMERICAN PSYCH SYSTEMS
APWU HEALTH PLAN
ASSURANT HEALTH SELF FUNDED
ASSURED BENEFIT ADMINISTRATORS
ASURIS
ASURIS NORTHWEST
AULTCARE OF OHIO
AVANTE
AVANTE HEALTH
AVMED INC
Aetna Pharmacy
Allways Health Partners
BAPTIST HEALTH PLAN
BCBS CAREFIRST
BCBS FEDERAL
BCBS of AK
BCBS of AL
BCBS of AR
BCBS of AZ
BCBS of CA
BCBS of CO
BCBS of CT
BCBS of DE
BCBS of FL
BCBS of GA
BCBS of HI
BCBS of IA
BCBS of ID
BCBS of IL
BCBS of IN
BCBS of KS
BCBS of KY
BCBS of LA
BCBS of MA
BCBS of MD
BCBS of ME
BCBS of MI
BCBS of MN
BCBS of MO
BCBS of MS
BCBS of MT
BCBS of NC
BCBS of ND
BCBS of NE
BCBS of NH
BCBS of NJ
BCBS of NM
BCBS of NV
BCBS of NY
BCBS of OH
BCBS of OK
BCBS of OR
BCBS of PA
BCBS of RI
BCBS of SC
BCBS of SD
BCBS of TN
BCBS of TX
BCBS of UT
BCBS of VA
BCBS of VT
BCBS of WA
BCBS of WI
BCBS of WV
BCBS of WY
BEACON HEALTH OPTIONS
BEACON HEALTH STRATEGIES
BEHAVIORAL HEALTH SYSTEMS
BENEFIT ADMINISTRATIVE SYSTEMS LLC
BIND HEALTHCARE
BLUE CROSS BLUE SHIELD
BLUE GRASS FAMILY HEALTH
BLUE SHIELD of CA
BOON CHAPMAN ADMINSTRATORS INC
BRIGHT HEALTHCARE
BUCKEYE COMMUNITY HEALTH
Blue Cross Blue Shield Maryland (Carefirst)
CAPITAL BCBS
CAPITAL DISTRICT PHYSICIANS HEALTH PLAN-CDPHP
CAREFIRST ADMINISTRATORS
CAREFIRST NETWORK LEASING
CARELON BEHAVIORAL HEALTH
CARESOURCE
CBA BLUE
CCSTPA
CENTRAL PENNSYLVANIA TEAMSTERS
CHAMPVA - HAC
CHRISTUS HEALTH PLAN TEXAS HIX
CIGNA
COLORADO MEDICAID
COMMUNITY CARE MGD. HLTHCARE PLANS
COMMUNITY HEALTH CHOICE TX - HIM
COMPANION LIFE
COMPSYCH
CONSOLIDATED HEALTH PLANS
CONSTRUCTION WORKERS TRUST FUND
CORESOURCE
COVENTRY HEALTH CARE
CUSTOM DESIGN BENEFITS INC.
CVS Caremark
CWI BENEFITS INC.
CYPRESS BENEFIT ADMINISTATORS
Caremark
Cigna Tel Drug
CitizenRx
DENVER HEALTH MEDICAL PLAN
EBAM
EDS HEALTHCHOICE OF OK
EMBLEM HEALTH
EMI HEALTH
EMPIRE BCBS
EMPLOYEE BENEFIT MGMT SERVICE
EMPLOYERS INS COMP OF NEVADA
ENTRUST
EVOLUTION
EXCELLUS BCBS
EXPRESS SCRIPTS
EnvisionRx
FIDELIS CARE OF NY
FIRST HEALTH NETWORK
FIRSTCARE
FLORIDA MEDICAID
FMH BENEFIT SERVICES INC.
FRIDAY HEALTH PLANS of CO
GATEWAY HEALTH PLAN
GEHA
GEISINGER HEALTH PLAN
GENERAL LABORS UNION LOCAL UNION 472
GHI
GLOBAL CARE
GLOBAL HEALTH OKC
GOLDEN RULE
GOVERNMENT EMPLOYEE HOSPITAL ASSOC GEHA
GROUP AND PENSION ADMINISTRATORS
GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI
GULF GUARANTEE
HARKEN HEALTH
HARTLAND
HARVARD PILGRAM
HAWAII MEDICAID
HEALTH ADMINISTRATIVE SERVICE INC
HEALTH ALLIANCE PLAN
HEALTH EQUITY, INC
HEALTH FIRST HEALTH PLAN
HEALTH NET
HEALTH PARTNERS
HEALTH PARTNERS NORTH
HEALTH PLAN ADMINISTRATORS
HEALTH SCOPE BENEFITS
HEALTH SELECT OF TX
HEALTH SPAN
HEALTHCARE STRATEGIES
HEALTHCHOICE
HEALTHFIRST OF NEW YORK
HEALTHGRAM
HEALTHNET FEDERAL SERVICES
HEALTHSMART
HEARTLAND
HIGHMARK BCBS
HMA - Hawaii Mainland Administrators
HMAA - Hawaii Medical Assurance Association
HMC HEALTHWORKS
HMSA - Hawaii Medical Service Association
HOMETOWN HEALTH PLAN NEVADA
HORIZON BLUE CROSSBLUE SHIELD OF NEW JERSEY
HUMANA
HUMANA CARESOURCE OF KENTUCKY
HUMANA MEDICARE
Healthkeepers
Humana Pharmacy
IHC HEALTH SOLUTIONS
IHS CLAIMS
INDEPENDENCE ADMINISTRATORS
INDEPENDENT HEALTH
INETICO INC.
INFORMED LLC
INGENIO Rx
INSURANCE MANAGEMENT SERVICES
INTEGRA GROUP
IngenioRx
JOHN HOPKINS HEALTHCARE
JOHNS HOPKINS MEDICAL SERVICE
K G ADMINISTRATORS SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII
KAISER PERMANENTE
KERN PPO - CALIFORNIA
KEYSTONE FIRST COMMUNITY HEALTH PLAN
KPIC
KPP
Kaiser Foundation Health Plan of Colorado
Kroger Pharmacy
LAKESIDE COMMUNITY HEALTHCARE
LIFESHIELD NATIONAL
LIFESTYLES HEALTH
LINECO
MAGELLAN
MAGNACARE
MAIL HANDLERS BENEFIT PLAN
MANAGED HEALTH NETWORK
MANAGED HEALTH NETWORK (MHN)
MARYLAND BLUE CROSS - CAREFIRST
MAXOR ADMINISTRATIVE SERVICES
MAYO CLINIC
MCGREGOR AND ASSOCIATES
MED CENTER HEALTH
MED PARTNERS
MEDBEN
MEDCOST BENEFIT SERVICES MBS
MEDICA IFB
MEDICA2
MEDICAL BENEFITS ADMINISTRATORS NEWARK OHIO
MEDICAL MUTUAL OF OHIO
MEDICARE PART A
MEDPARTNERS
MEDSTAR HEALTH PLAN
MEMORIAL HEALTHCARE SYSTEM
MEMORIAL HERMAN
MENTAL HEALTH CONSULTANTS
MERIDIAN HEALTH PLAN
MERITAIN HEALTH
MERITAIN HEALTH MINNEAPOLIS
MODA HEALTH PLAN
MOLINA HEALTHCARE of CA
MOLINA HEALTHCARE of FL
MOLINA HEALTHCARE of UT
MVP HEALTH PLANS
Maryland Medicaid
Mass General Brigham Health Plan
Med-Impact
Medicare Part B
Michigan Medicaid
Molina Complete Care of Virginia
Molina Healthcare of Texas
NATIONAL ELEVATOR INC.
NEW YORK GROUP HEALTH
NEX CALIBER
NGS AMERICAN INC.
NORTH AMERICAN ADMINISTRATORS
NORTHEAST GEORGIA HEALTH SERVICES
OHANA HEALTH PLAN (WELLCARE OF HAWAII)
OPTIMA
OPTIMA/SENTARA
OPTUM
OXFORD HEALTH PLANS
OptumRx
Oscar Health
PAI
PAN-AMERICAN LIFE INSURANCE
PARAMOUNT HEALTH
PARAMOUNT HEALTH CARE
PENN BEHAVIORAL HEALTH
PHILADELPHIA AMERICAN LIFE INS CO
PHILADELPHIA AMERICAN PHCS
PIEDMONT BEHAVIORAL HEALTH
PIEDMONT COMMUNITY HEALTH INSURANCE
PLANNED ADMINISTRATORS INC.
POMCO
PREFERRED ONE
PREMERA
PRESBYTERIAN HEALTH
PRIMARY PHYSICIANCARE INC.
PRIORITY HEALTH OF MICHIGAN
PRUDENT BUYER PLAN
PUBLIC EMPLOYEE HEALTH PLAN PEHP
Prime Therapeutics
QUALCARE
QUALCARE DBA QANI ADMINISTRATORS
QUALCHOICE
QUALCHOICE OF ARKANSAS
QUEST BH
RURL CARRIER BENEFIT
SANA BENEFITS
SANFORD HEALTH PLAN
SCOTT AND WHITE HEALTH PLAN
SECURITY HEALTH PLAN
SEDGWICK CLAIMS
SELECT BENEFIT ADMINISTRATORS
SELECT HEALTH OF UTAH
SELECTHEALTH OF SC
SEMINOLE TRIBE OF FLORIDA
SIERRA HEALTH SERVICES
ST MARYS HEATLH PLAN
SUMMACARE HEALTH PLAN
Scott & White Rx
TEAMSTERS
THE HARTFORD
THE LOOMIS COMPANY
TML MULTI STATE
TOTAL CARE NETWORK
TRICARE - EAST
TRICARE - WEST
TRICARE FOR LIFE
TRISTAR BENEFIT ADMINISTRATORS TPA
TRUSTEED PLANS SERVICE CORPORATION
TRUSTMARK
TUFTS HEALTH PLAN
True Scripts
UHC SHARED SERVICES
UHC STUDENT RESOURCES
UMR
UNI
UNITED HEALTHCARE
UNIVERSITY OF UTAH HEALTH PLANS
UPMC HEALTH PLAN COMMERCIAL
US Family Health Plan
USAA
UTAH MEDICAID
University of Iowa Rx
VIRGINIA MEDICAID
VIVA Health
Vantage Health
Virginia Medicaid
WEB TPA
WELLCARE HEALTH PLANS
ZELIS PREFERRED
ZELLUS HEALTH SOLUTIONS
Please selec at least one option
What is the client’s age range?
0-5
6-9
10-12
13-15
16-17
18-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
66-70
71-75
76-80
81-85
86-100
Please select age range.
First biological legal guardian's first and last name, email address, and phone number
Primary Legal Guardian’s Full Name
Primary Legal Guardian’s Email
Primary Legal Guardian’s Phone Number
This field is required.
Second biological legal guardians first and last name, email address, and phone number?
Secondary Legal Guardian’s Full Name
Secondary Legal Guardian’s Email
Secondary Legal Guardian’s Phone Number
This field is required.
Any other legal guardians (with medical decision making) first and last name, email address, and phone number?
Other Legal Guardian’s Full Name
Other Legal Guardian’s Email
Other Legal Guardian’s Phone Number
This field is required.
Please select client’s gender:
Male
Female
Transgender
Gender neutral
Non-Binary
None or a combination of the above
Please select a gender.
What are you seeking services for? (Check which apply, maximum of 2)
Spanish-speaking/bilingual Spanish speaking therapist
A BIPOC therapist
A therapist in the LBGTQIA+ community or allied
Addiction/ Active Substance Abuse
Substance use in remission/sobriety maintenance
ADD/ADHD
Anxiety/Stress
Anger Management
Autism/ASD/ Neurodiverse
Bipolar disorder
BPD (Borderline Personality Disorder)
Chronic Pain
Chronic Disease/Illness
Codependency
Couples Therapy/Marital Counseling
Court-Ordered Therapy
Depression
Dissociative Identity Disorder (DID) - Multiple Personality
Eating Disorders (ED)
Faith Exploration/Spirituality Exploration
Family Therapy
Gender Dysphoria
Grief & Loss
Aging/End of Life
Hoarding
Identity Exploration
Infidelity Couples Counseling
Intimacy Couples Counseling
Learning Disabilities
Mens Issues
Military/Veteran Issues
Narcissism/Narcissistic Personality Disorder
OCD (Obsessive Compulsive Disorder)
Parenting Issues
Phobias
Postpartum Depression/Anxiety
Psychosis
Trauma & PTSD
CPTSD/Complex PTSD
Religious Abuse/Trauma
Schizophrenia
Sex/ Sexuality Issues (Individual Client)
Sex/ Porn Addiction
Sexual Disorders
Sex Offenders
Suicidal Ideation
Suicidal with Plan (non-crisis/no intent to harm)
Survivors (Narcissistic, Domestic Violence)
TBI (Traumatic Brain Injury)
Trans/ Nonbinary Issues
Infertility/IVF
Polyamorous/ENM (Individual)
Polyamorous/ENM (Couples Therapy)
Financial Stress
Attachment/Insecurities
Sexual Trauma
Mandarin Chinese-Speaking/Bilingual Therapist
Please selec at least one option
Is there a specific type of therapy treatment method you are seeking?
Yes
No
Please selec at least one option
What therapy treatment method are you seeking? (Check which apply, maximum of 2)
Art Therapy
CAMS SSF-4
CBT (cognitive behavioral therapy)
DBT (dialectical behavioral therapy)
ACT (acceptance and commitment therapy)
IFS (Internal Family Systems Model) (treatment method)
Inner Child Work
EFT (emotionally focused therapy)
EMDR
Brain Spotting
Biofeedback
The Gottman Method
Gestalt
HAES (Health at Every Size)
Mindfulness
Mind-Body Connection
Narrative
Neurofeedback
PACT (Psychobiological Approach To Couples Counseling)
REBT
Parent-Child Interaction
Play Therapy
Psychodynamic
Sex Therapy
Solutions Focused (short-term treatment method)
Spiritual Integration
Satir Transformational Systemic Therapy
Somatic
Exposure and Response Prevention (ERP, phobia treatment)
Spanish-Speaking Therapy
Christian Counseling
NeuroAffective Relational Model (NARM)
Mandarin Chinese-Speaking Therapy
Couples/Marital Counseling
Please selec at least one option
Do you require in-person visits only, or are you open to Telehealth video appointments?
I am open to Telehealth video apppointments (More options available via telehealth)
I only want in-person provider options
Please selec at least one option
For In-Person Sessions Which Area Below Works Best For You?
Lakewood or Denver areas of Colorado
Boulder/Longmont
Fort Collins
Colorado Springs/Pueblo
Glenwood Springs
Please selec at least one option
How did you hear about us?
Psychology Today
Google Search
Mental Health Match
Current Higher Sights Provider
Current Higher Sights Client
Instagram
FaceBook
Other
Please selec at least one option
Next
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Higher Sights providers can only perform services to clients located in the state of Colorado. Please reach out to us once you are able to attend services in the state of Colorado.
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