Request appointment | Alabaster Counseling

Payment method

How do you plan to pay?

Primary Insurance Carrier

Insurance card upload

Upload a photo of your insurance card

If Medicaid, please list your specific plan:

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Member ID #

Relationship of the Primary Insurance Holder to the Client

Do you have a Secondary Insurance Plan?

If Yes, Enter name of plan

First & Last Name and Date of Birth of Primary Insurance Holder

If not the same as client

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If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.