Group Application Forms

Group Authorization Form

Individual Authorization for Release of Information

To complete with a digital signature and send electronically, please download this form with Adobe or another PDF reader.

Individual Authorization for Release of Information (Español)

Para completar con una firma digital y enviar electrónicamente, por favor descargue esta forma por el Adobe u otro lector PDF.

Individual Payment Authorization Form
Claim Form
Claims Appeal Procedures
Agent Contracting Request Packet
HIPAA Notice of Privacy Practice and Rights
Privacy Notice (Gramm-Leach-Bliley)
Non-Discrimination Notice

Non-Discrimination Notice (Español)