Verification of Benefits

Our verification of benefits is completed by our trusted friends at Favored Medical Billing Service. Your verification will be provided to Blossom  from Favored within 2-3 business days. Upon receipt of your completed verification, Blossom will contact you to discuss your estimated patient responsibility.

If you do not hear from our staff at Blossom after 2-3 business days, please contact the office at (602) 256-7766 or email through our contact form.

To receive your benefit breakdown, please complete this form in its entirety.


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Patient Information:


Insurance Information:


Additional Notes and Questions

Please provide any additional questions or requests regarding your verification below:


Secondary Insurance Policy

IF you have a secondary policy please complete the section below: