Sabrena Shields
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2
Client information
Legal first name
Legal last name
Add a chosen name and pronouns (optional)
Email
Phone number
Date of birth
Sex listed on insurance
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3
Insurance options
Insurance
Carrier name
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Member ID
Where can I find this?
Verify coverage
Am I covered?
Check if this provider is in-network.
Cash, Out-of-pocket
4
Billing information
Why do we need this?
Credit, Debit, or HSA Card
PCI Encryption
5
Residential address
Why do we need this?
Residential address
This should be in the state from which you'll receive care
Apartment # or Suite (optional)
Add Apartment # or Suite (optional)
City
State
Georgia
Zip code
I have reviewed and accept the
practice policies
of Grow Therapy
Worry-free booking
It's free to cancel your virtual or in-person appointment up to 24 hours before the appointment begins for any reason.
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60 min
Virtual
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