HIPAA Authorization PDF Plus

Please enter your billing information and email address. Then you will be redirected to our custom input form. 

  • Create a login so that you can go back and review the form before you submit it. Keep your login information handy.
  • Share this page and your login information with your adult child so they can review, sign, and submit the form. They can access the form from the top of any page on our website by clicking UPDATE FORMS.
  • 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.
  • Anytime you need a fresh copy, or want to change your authorization, visit our website and click UPDATE FORMS to login to access your information.