Insurance Verification Form

We understand that insurance and funding, in general, can be overwhelming. You can find some additional information here or you can talk to our admissions team at 435-272-1280

ThreePeaks Ascent values and respects your privacy. ThreePeaks Ascent will make every effort to ensure that the information you provide to us is kept private and only shared with individuals/organizations that you approve of.

Your Information


Insurance Information

Policy Holder Name(Required)

Child Information

Child's Name(Required)
MM slash DD slash YYYY


This field is for validation purposes and should be left unchanged.