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 details

Please state what Insurance you will be using- the name on the top of the card.

Limited to 600 characters

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 using an EAP, please be Specific about what EAP Network you want to use. (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

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.