Insurance Verification Form

Insurance verification forms for Dr. Phillips office, in Orlando for new patients of therapeutic counseling

Thank you so much for your interest in Life Skills Resource Group. In order to best serve we would like to provide the service of checking on your Insurance and how your benefits can work with LSRG.

Please note that we are not In Network Providers for any Insurance company. Many people have excellent Out of Network Plans and we can creatively work with most to serve your needs.

If you choose to go with an In Network Provider after we have provided you the information we are happy to review you In Network Provider list and make suggestions.

By providing this information you are authorizing a Life Skills Resource Group representative to contact your insurance on your behalf.

Insurance Policy
If you are using insurance, and your claims are denied or your insurance company does not provide reimbursement for any reason, you are responsible for the full cost of the session.

Insurance Verification Form

  • As it appears on insurance card
  • Date Format: MM slash DD slash YYYY
  • This is person employed by company that provides the insurance
  • Date Format: MM slash DD slash YYYY
  • (who provides insurance)
  • On back of insurance card
  • if there is separate number
  • This field is for validation purposes and should be left unchanged.

Proudly serving clients in Central Florida’s Orange County and Osceola County, including Orlando, Southwest Orlando, Dr. Phillips, Metrowest, Windermere, Gotha, Hunters Creek, Hunter’s Creek, Ocoee, Winter Garden, Celebration, Southchase, Poinciana, Lake Nona, Lake Wales, Southchase, Bay Hill, Clermont, Lakeland, Minneola, St. Cloud, Lake Buena Vista, Walt Disney World, Universal Studios, Mount Dora, Davenport, Haines City, Conway, Groveland, Azalea Park, Sebring, The Villages, Avalon Park, UCF, East Orlando, Waterford Lakes, Oviedo, Maitland, Winter Park, Altamonte Springs, Kissimmee, Longwood, Apopka, College Park, Orlando, Dr. Phillips, Metrowest, Windermere, Gotha, Hunters Creek, Ocoee, Winter Garden, Celebration, Southchase, Orange County, Osceola County.