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Email: forward@lift-ife.com
Call: 414-775-2677
About Us
Services
CCS CHILDREN
CCS ADULT
CHILDREN YOUTH FAMILY SERVICES
MEDICAID/COMMERCIAL INSURRANCE
CCS CHILDREN/ADULT ( KENOSHA )
Contact
Insurance Verification
Insurance Verification Policy
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Insurance Verification
Full Name
Guardian's name
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Phone
Email
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Address details
City
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Postal / Zip code
Country
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Do you have more than one insurance company? If so, which is your primary and secondary?
Insurance Company:
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Primary or Secondary?
Make a choice
Insurance Company:
Primary Care Doctor Name
Insurance ID:
Phone
Address
Reason for coming for in for services
Preference for times available
Type of session
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