HIPAA Authorization PDF For All Adults

Please enter your billing information and email address. Then you will be redirected to our custom input form. Only the individual granting authorization can sign the form. 

  • Create a login and keep your login information handy.
  • Enter payment information, then have the individual granting authorization and fill out the form and electronically sign. 
  • Be absolutely sure that your information is correct. Once you hit SUBMIT, we will generate your HIPAA authorization in PDF format and it will be emailed instantly to both of the email addresses on the form.