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About
Who We are?
Recognized by the State Of California
What Our Alumni Say?
Why Hillside Laguna
Life at Hillside
Outdoor Activities & Adventure
Treatment
We prepare you for a lasting & healthy recovery
Detox Services
>
Medically Assisted Detox Referral
Alternative Detox NAD IV Therapy Referral
Individual Treatment
Family & Couples Program
Support Community - AA or Smart Recovery
NAD IV Therapy
Holistic Program
Our Team
Staff
Clinical Excellence & Integrated Team Work
Weekly Program
Admissions
Private Cash Pay & Insurance
Alumni Feedback
Research & Resources
Clinical Blogs
Mental Health & Psychology Blog.
TED Talks Video Library
Take the Test
>
Take the Test - Am I Alcoholic?
Take the Test - Am I a Drug Addict?
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Check Your Insurance Benefits
We accept most PPO insurance plans. Submit the form below and we will promptly verify your coverage and available payment options
*
Indicates required field
Insured's Name (Policy Holder)
*
First
Last
Name of Insurance Policy Holder, patient, father, mother or spouse
Patient's Name (If different)
*
First
Last
Name of person seeking treatment
Patient's Date of Birth
*
Phone / Cell
*
Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Please provide additional comments
*
Insurance Company
*
Insurance Company Phone Number
*
Member ID No. (include alpha-prefix)
*
Group Number
*
State level of care desired:
*
DETOX
RESIDENTIAL
IOP ( Intensive Outpatient)
List substances, Prescription drugs & Amounts?
*
Have you been in treatment in the last 90 days?
*
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No
When do you wish to admit?
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Upload front of insurance card
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Max file size: 20MB
This option allows you to attach & send us a copy of your insurance card. It’s recommended to take a snap shot of the front and back of your insurance card before starting to fill out this form.
Upload back of insurance card
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Max file size: 20MB
Upload copy of your Drivers License
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Max file size: 20MB
This option allows you to attach & send us a copy of your insurance card. It’s recommended to take a snap shot of the front and back of your insurance card before starting to fill out this form.
Name of person who filled this form
*
Who referred you to us?
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SUBMIT
Call Now (310) - Hillside (310) 445-5743
About
Who We are?
Recognized by the State Of California
What Our Alumni Say?
Why Hillside Laguna
Life at Hillside
Outdoor Activities & Adventure
Treatment
We prepare you for a lasting & healthy recovery
Detox Services
>
Medically Assisted Detox Referral
Alternative Detox NAD IV Therapy Referral
Individual Treatment
Family & Couples Program
Support Community - AA or Smart Recovery
NAD IV Therapy
Holistic Program
Our Team
Staff
Clinical Excellence & Integrated Team Work
Weekly Program
Admissions
Private Cash Pay & Insurance
Alumni Feedback
Research & Resources
Clinical Blogs
Mental Health & Psychology Blog.
TED Talks Video Library
Take the Test
>
Take the Test - Am I Alcoholic?
Take the Test - Am I a Drug Addict?