Forms & Carrier Information

An authorization form allowing the carriers to share your health history and related health information with a third party, whom you’ve designated require carrier specific forms. See below for the specific form that your carrier requires given HIPAA.

These forms are provided for reference. We encourage you to call your carrier for any updates on specific authorization  requirements. 

If a provider doesn’t have a form below, then unfortunately, they do not  provide a blank form to be kept on hand as forms are updated regularly. If, at any time, you need an authorization form they will gladly provide the form to the policy holder.

          Provider / Policy Holder Customer Service Number