Daniel Hernandez, Sr. LCSW-S, CIMHP, CSTIP, CPLC
he/him
Grow Verified
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Accepting EAP:United Health/Optum
1
Select a day and time
Virtual
December 2023
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Thursday Dec 21st
3:00 PM - 4:00 PM UTC
3:30 PM - 4:30 PM UTC
4:00 PM - 5:00 PM UTC
2
Client information
Legal first name
Legal last name
Add a chosen name and pronouns (optional)
Email
Mobile phone number
Date of birth
Sex listed on insurance
Select an option
3
Insurance options
Insurance
Insurance name
EAP:United Health/Optum
Member ID
Where can I find this?
EAP Auth Code
You can get this information from your insurance provider
EAP Number of Visits
Verify & estimate cost
Am I covered?
Check if this provider is in-network and see your estimated cost.
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 the client will receive care
Add Apartment # or Suite (optional)
City
State
Arizona
Zip code
I have reviewed and accept the
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practice policies
 of Grow Therapy
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60 min
Virtual
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