Request appointment | Thrive Mental Health Services

PAYER SOURCE QUSTIONS:

How do you plan to pay? Select all that apply

Insurance Employee Assistance Program (EAP) Out of pocket (Self-Pay)

Insurance card upload

Upload a photo of your insurance card

PAYER SOURCE: If using Insurance, who is the Primary Insured & What is their relationship to the Client?

(ex: self, parent, spouse, legal guardian)

Limited to 600 characters

PAYER SOURCE: If using an EAP, what is the name of the EAP?

(if not using an EAP, just type NA)

Limited to 600 characters

If using an EAP, who is the Employee and what is their relationship to the Client?

(if not using an EAP, just type NA)

Limited to 600 characters

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.