The Ohana Hawaii

Confidential Insurance Benefits Verification Form

Lets collect Some infomation from you first.

First Name*

Last Name*

Email Address*

Phone Number*

Address*

Address 2

City*

Zip Code*

DOB*

Are you the Primary Policy Holder for this insurance policy?

Yes

Insurance Card Provider*

Member ID #*

Customer Service Phone # (Back of Card)*

Briefly describe what substances you're struggling with and if you've ever been in treatment before. You can also use this area to add any additional information/questions that you may have for our team.

Message*

0 / 150

After pressing the submit button below, please wait up to one minute for your insurance data to be securely transmitted.

We can help

The Ohana has a specialized team to help answer the question of what is at the core of your addiction. With trauma informed, adventure filled, and evidence based practices; we get to that core of addiction and provide you tools to maintain sobriety. Start your journey toward recovery today!

Confidential Insurance Benefits Verification Form

DOB*

CALL US TODAY

We can help