Patient Information

Patient First Name
Patient Last Name
Patient Email
Patient Telephone
Patient DOB
Patient Social Security #
Patient Address 1
Patient Address 2
Patient City
Patient State
Patient Zip Code

Policy Holder Information

  Check This Box If You Are The Policy Holder

Policy Holder First Name
Policy Holder Last Name
Policy Holder Relationship
Policy Holder Email
Policy Holder Telephone
Policy Holder DOB
Policy Holder Social Security #
Policy Holder Address 1
Policy Holder Address 2
Policy Holder City
Policy Holder State
Policy Holder Zip Code

Policy Information

Insurance Company
Insurance Company Telephone (Back of Card)
Policy/Member Number
Group ID
Plan Type
Additional Comments
In accordance with HIPPA and your rights to how your private health information is handled, by submitting the above information, you are authorizing Royal Life Centers to contact you via the method you supplied. During normal business hours, we can usually verify your benefits in about an hour. However during hours aside from normal business hours, we will be able to verify your benefits first thing the following morning and return your request for help. The information you provided above will be used by our Admissions Department to assist you with all of your options while seeking treatment. We are fully committed to your privacy and confidentiality. Your information will not be used for any other purpose other than to help you find treatment and your information will not be shared with any third parties.

Thank you!

Your insurance information has been sent for verification.

Why Choose Royal?

Professional Medical Supervision

Effective Same Day Treatment

Private Comfortable Rooms

Around The Clock Care

Certified Addiction Therapists


Drug Addiction Support Staff

Our Mission

Royal Life Centers has been created to provide you unparalleled, quality treatment. We have merged the best facilities in Washington State to provide you the best treatment possible. No two individuals are exactly alike. Your recovery process requires specific needs that are unique to your life experiences and personality. Centered in a holistic approach to the recovery of mind, body, and spirit, Royal Life Centers equips you with the tools needed to reclaim your life.

Royal Treatment

During all phases of our program, you will be in a safe and welcoming environment equipped with highly trained staff members who understand your emotional needs while embarking on this journey. Our program's quality is superior because the we are ethical, comprehensive, supportive, and always focused on what is best for you and your specific needs.