Teen Healthy Connections Registration Form

Insurance:

To use your insurance, we need you to fill out the Registration and Screening Form for group participation. Also, prior to the first group attended, an intake session will be required to obtain a basic history and understand the issues the participant struggles with.

When using your insurance, your regular copay, coinsurance, or deductible will apply, and you will be billed for your regular Patient Responsibility as per your coverage determination.

After submitting this form and completing the Registration form, we will reach out to you in a day or two to schedule your child's intake with one of our group leaders.

Insurance:

Great! Since you are already a patient, we have your information all set. You will be responsible for your usual copay, coinsurance or deductible, and you will be billed for your regular Patient Responsibility as per your coverage determination.

After submitting this form, we will reach out to you within a day or two to confirm your participation.

Fee Paying

The simplest and quickest way to enroll your child.

You will be able to make a payment for one or more groups below. Discounts are built-in the more groups you register for.

Your payment will reserve their spot in the next upcoming group(s). If your child doesn't attend the next one, your payment will count towards the one they do attend.