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You can get the information and care that you need quickly with these commonly-requested forms.
At some point during your care, you may want us to disclose your protected health information to someone else, like a partner or child. Here you’ll find the form you’ll need to authorize the release of that information.
If you're looking to be reimbursed for eligible out-of-pocket medical expenses, be sure to submit this reimbursement request form within 180 days of the date of service.
Let us know if you're having any problems with your current plan or plan provider so we can help. Here's how to file a formal complaint or appeal.
Continuity of care means continued services, under certain conditions, with your current health care provider until your provider completes your care. Find out if you qualify and learn how to submit a request by visiting the webpage.
Download our privacy practices ➜
Let’s talk. Call us at (855) 995-5004 or send us a message