Rum River Counseling, Inc. Registration Update Form
Note: If you are experiencing a medical emergency please dial 911 to contact local emergency response personnel.
Please be assured that this online registration update form is a secured and that information entered and submitted is confidential.
You may also contact us by phone.
Twin Cities area: (763) 482-9598
Attention: If you are not the intended client, please be sure to fill this form out with the appropriate client information.

CURRENT CLIENT REGISTRATION INFORMATION UPDATES
Required Information
*
*
*
*

PLEASE INDICATE ANY UPDATES TO THE FOLLOWING:


INSURANCE INFORMATION UPDATES
*
*
*
SECONDARY INSURANCE INFORMATION UPDATES

CONTACT INFORMATION
Please bring your new insurance card(s) to your next appointment. We are required to make a copy of your insurance card for the file. If you are providing new insurance information, please note that verification of coverage may take up to 3 business days, so you will need to follow up with your therapist to ensure that this has been completed prior to your appointment or you will need to pay out of pocket at that time. If you have more than one insurance policy, please contact both policies to update coordination of benefits or your claims will deny and result in full patient responsibility. We will follow up with you if we discover any coverage issues, so please provide the best contact information to reach you. Thank you.
*
* CAPTCHA