Appointment Requesting

******Insurance & Payment********:
Benevolent  Wellness doesn't participate  with  insurance plans and payment  is due at the time of service. 
Upon request, we can provide an itemized receipt/superbill that you may submit directly to your insurance company for possible out-of-network reimbursement. Reimbursement is determined by your individual insurance plan and is not guaranteed.  

HSA card are accepted for eligible service. 
Payments made by credit cards, any applicable card surcharge will be disclosed in advance and will not exceed the amount permitted by applicable law and card-network requirements.  


*** Please Note *****
Submitting this form is an appointment request and does not reserve an appointment. After receiving your request, we will contact you with available appointment times. Your appointment is confirmed only after you accept the offered time and receive a confirmation from our office.

For new patients, please contact the office at 973-512-8493 to provide a credit card to hold the appointment. In the following request, please leave your mobile phone number that could receive text messages.