Check My Benefits Patient Name* Patient Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Insurance Company* Insurance ID #* Group #* Subscriber Name* Subscriber Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*Which services are you interested in?* Diagnosis/Concerns*Which CEPT location are you seeking services from?* Allen, Texas Mansfield, Texas Insurance CardPlease scan or take a picture of the front and back of your insurance card and upload it here. Drop files here or Select files Max. file size: 256 MB. Drivers LicensePlease scan or take a picture of your drivers license and upload it here. Drop files here or Select files Max. file size: 256 MB. If you are unable to upload your items, don't worry! You can just take pictures with your phone and email the photos to us with the patient's name in the subject line, and we can attach them for you. Email Allen | Email Katy | Email MansfieldCAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ Therapy with a purpose – it's imitated, but not replicated. GET STARTED!
