Book Care | Cleo

About You

First name

Last name

Phone

Zip code

Where You Are

Where are you in your journey?

What You're Looking For

What kind of support are you interested in? (select all that apply)

Tell us more about what you're looking for (optional)

Insurance

Mental health support, pelvic floor physical therapy and lactation consultations may be covered under your insurance plan*. Once booked, we help check your eligibility where applicable and navigate insurance related headache for you.

Would you like help navigating insurance coverage?

Tell us about your insurance plan

Insurance provider

Plan name

Member ID

Group number

Date of birth

Home address (for insurance claims)

Are you the primary policyholder on this plan?

Anything else we should know about your coverage? (optional)

If a service isn't covered by your insurance, would you still like to be matched with a provider?

Required · Insurance Authorization

To verify your benefits and submit claims on your behalf, we need your authorization below.

1. Authorization to Release Health Information

I authorize Cleo Care, LLC and its designated staff to contact my insurer and to request, receive, and discuss information regarding my insurance coverage and benefits for the purpose of verifying my eligibility. This may include my plan status, deductible and out-of-pocket amounts, copay and coinsurance details, coverage for specific services, and any prior authorization requirements. I may revoke this authorization at any time in writing.

2. Authorization for Claims Submission

I designate Cleo Care, LLC as my authorized agent for submitting health insurance claims on my behalf. All reimbursements are issued directly to me. Cleo will not receive or redirect any funds. Cleo acts solely as a submission agent and is not an insurance company or claims adjudicator. I may revoke this authorization at any time in writing.

Full legal name (electronic signature)

I have read and agree to both authorizations above. I understand that typing my name acts as my electronic signature.

How did you hear about Cleo?

Are you currently covered by Medicaid / Medi-Cal, TRICARE, or IHS?

I have read and agree to Cleo Care’s Terms of Service and Privacy Policy, including how my health information is collected and shared with the providers I’m matched with.

Your concierge will be in touch within 48 hours to confirm your plan.

*Insurance coverage varies by plan. Cleo makes no guarantee of reimbursement.

Full-Spectrum Maternal Care

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Let's find the care that's right for you.