Extra Mile Recovery

We appreciate all feedback from our clients and their loved ones, even when it’s not always positive. Please let us know what we could’ve done to improve your experience

Name(Required)

Phone(Required)

Email(Required)

Review(Required)

69954

Cleantalk Pixel

APPLY FOR TREATMENT

Full Name*
First Last
Applying For:*
D.O.B.*
Phone*
Email*
Insurance Name
Member ID
Comments
This field is for validation purposes and should be left unchanged.

41475

Schedule A Consultation

Name*
First Last
Phone*
Email*
Preferred Date*
MM slash DD slash YYYY
Preferred Time*

: HH

MM

AM/PM
How Can We Help?

69065

Send Us A Message

First Name*
Last Name*
Phone*
Email*
How Can We Help?
Name
This field is for validation purposes and should be left unchanged.

94221

INSURANCE VERIFICATION

Full Name*
D.O.B.*
Phone*
Email*
Insurance Name*
Member ID
Email
This field is for validation purposes and should be left unchanged.

59633